Perspectives on menopause and women with HIV

Abstract

Since the implementation of effective combination antiretroviral therapy, HIV infection has been transformed from a life-threatening condition into a chronic disease. As people with HIV are living longer, aging and its associated manifestations have become key priorities as part of HIV care. For women with HIV, menopause is an important part of aging to consider. Women currently represent more than one half of HIV-positive individuals worldwide. Given the vast proportion of women living with HIV who are, and will be, transitioning through age-related life events, the interaction between HIV infection and menopause must be addressed by clinicians and researchers. Menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely. This transitional time in women’s lives has various clinical implications including physical and psychological symptoms, and accelerated development and progression of other age-related comorbidities, particularly cardiovascular disease, neurocognitive dysfunction, and bone mineral disease; all of which are potentially heightened by HIV or its treatment. Furthermore, within the context of HIV, there are the additional considerations of HIV acquisition and transmission risk, progression of infection, changes in antiretroviral pharmacokinetics, response, and toxicities. These menopausal manifestations and complications must be managed concurrently with HIV, while keeping in mind the potential influence of menopause on the prognosis of HIV infection itself. This results in additional complexity for clinicians caring for women living with HIV, and highlights the shifting paradigm in HIV care that must accompany this aging and evolving population.

Age Differences by Sex in Antiretroviral-Naïve Participants: Pooled Analysis from Randomized Clinical Trials

“…Therefore, age was used as an indirect measure for menopause such that women entering the trial at ages 50 or older were categorized as being post-menopause. This approach aligned with the median age of menopause among women living with HIV of 47 to 50 years as reported in prior systematic reviews during the development of our study (Andany, Kennedy, Aden, & Loutfy, 2016; Kang & Fantry, 2016; Kojic et al, 2007).…”

Associations of menopausal age with virological outcomes and engagement in care among women living with HIV in the UK

“…31,32 Furthermore, it is important to acknowledge the psychosocial impact of factors such as caring responsibilities and declines in health over a woman's lifetime, with consequent effects on mental health. 33,34 Further limitations include a lack of lifestyle data (e.g. alcohol consumption, smoking habits) which may have an impact on the timing and symptoms of menopause as well as ART adherence.…”

Elderly HIV-positive women: A gender-based analysis from the Multicenter Italian “GEPPO” Cohort

“…Sexually active post-menopausal women may be less likely to use condom as long as they are not worried about becoming pregnant [4]. Moreover, the physiological thinning and increased dryness of the vaginal mucosa after menopause may expose elderly women to a higher risk of HIV transmission [5]. Smit et al estimated that by 2030, 73% of HIV infected patients will be aged 50 years or more.…”