The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV

Solomon, Danielle; Sabin, Caroline; Burns, Fiona; Gilson, Richard; Allan, Sris; Ruiter, A de; Dhairyawan, Rageshri; Fox, Julie; Gilleece, Yvonne; Jones, Rachael; Post, Frank; Reeves, Iain; Ross, Jonathan; Ustianowski, Andrew; Shepherd, Jane; Tariq, Shema

doi:10.1080/09540121.2020.1748559

Cited by 24 publications

(26 citation statements)

References 18 publications

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“…3 Only a few studies have specifically examined the association between menopausal symptoms and adherence to antiretroviral therapy (ART). [4][5][6][7] A recent analysis of the Positive Transitions through the Menopause (PRIME) study, a cross-sectional study of women living with HIV in the UK aged 45-60 years, reported a significant association between severe menopausal symptoms and both sub-optimal adherence and HIV clinic attendance. 7 Despite the significant impact of sub-optimal adherence and poor clinic attendance on clinical outcomes, 8,9 there are currently no clear data on whether clinical HIV outcomes change among women as they progress through different stages of the menopause.…”

Section: Introductionmentioning

confidence: 99%

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

Tariq

Burns

Gilleece

et al. 2020

HIV Research & Clinical Practice

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Background: Women ageing with HIV undergo sex-specific changes. There is limited evidence available with regards to how the menopause impacts HIV outcomes. Objective: To investigate whether menopausal age is associated with engagement-in-care (EIC), viral load (VL) suppression and rebound among women living with HIV. Methods: Women were grouped by age (<40, 40–50, >50 years), corresponding to pre-, peri- and post-menopausal stages. EIC, HIV VL suppression (VL < 50 copies/mL) within 12 months of antiretroviral therapy initiation and VL rebound (two consecutive VL > 50 copies/mL) after VL suppression were compared across age groups using logistic/Cox proportional hazards regression. Associations were compared to those seen in heterosexual men. Results: Six thousand four hundred and fifty-five (6455) eligible women (median age 36 [interquartile range: 29–42], 64.4% black African, 19.1% white) contributed 44,226 person-years (PYRS) of follow-up; 29,846, 10,980 and 3,399 PYRS in those aged <40, 40–50 and >50, respectively. Women were engaged-in-care for 79.5% of follow-up time, 3,344 (78.0%) experienced VL suppression and 739 (22.1%) VL rebound. After adjustment, women aged >50 years had lower EIC than those aged <40. Women aged 40–50 were more likely to have VL suppression and were less likely to experience VL rebound than those aged <40 years. Trends in heterosexual men were similar for EIC but with no evidence of a higher VL suppression rate in those aged 40–50 years ( p int. 0< .0001) and a stronger protective association between older age and VL rebound ( p int. 0< .0001). Conclusion: Our findings warrant further research into the potential impact of the menopause to support women and clinicians through HIV care.

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Section: Introductionmentioning

confidence: 99%

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

Tariq

Burns

Gilleece

et al. 2020

HIV Research & Clinical Practice

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“…Menopausal symptoms may undermine ART adherence [ 18 , 43 ]. In this study, women had good level of adherence and a good immunological status.…”

Section: Discussionmentioning

confidence: 99%

“…Menopausal status was self-reported, as, in other similar published studies [ 9 , 11 , 22 , 23 ], and was categorized as: pre-menopausal, if a woman had regular menstruation; peri-menopausal, if a woman reported amenorrhea for at least three months in the previous year; and post-menopausal, if a woman had 12 consecutive months of amenorrhea. Women who had a history of hysterectomy and/or bilateral oophorectomy were excluded.…”

Section: Methodsmentioning

confidence: 99%

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

Suárez‐García

Alejos²,

Pérez-Elías

et al. 2021

BMC Women's Health

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Background To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45–60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45–50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38–6.55 and 2.63; 1.44–4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13–4.14) and urogenital symptoms (2.54; 1.42–4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74–13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women.

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“…1 Among women living with HIV, menopausal symptoms are associated with psychological distress 1 and decreased adherence to ART (which is important in terms of women’s own health and also the prevention of HIV transmission to others). 5 Use of systemic and topical hormone replacement therapy (HRT) is very low among women living with HIV (8% and 3%, respectively) despite the high prevalence of symptoms. 1 …”

Section: What Is the Impact Of The Menopause On Women Living With Hiv?mentioning

confidence: 99%

“…Among women living with HIV, menopausal symptoms are associated with psychological distress 1 and decreased adherence to ART (which is important in terms of women’s own health and also the prevention of HIV transmission to others). 5…”

Section: What Is the Impact Of The Menopause On Women Living With Hiv?mentioning

confidence: 99%

British Menopause Society Tools for Clinicians: HIV and the menopause

Tariq

2019

Post Reprod Health

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The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV

Cited by 24 publications

References 18 publications

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

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

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

British Menopause Society Tools for Clinicians: HIV and the menopause

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