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Conway R, Evangeli M. How is Aging Perceived to Affect Well-being in Women Older than 50 Years Living With HIV? A Qualitative Systematic Review. J Assoc Nurses AIDS Care 2023; 34:409-431. [PMID: 37543735 DOI: 10.1097/jnc.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Advances in HIV treatment have led to more people with HIV living to 50 years and older. No reviews have qualitatively analyzed and synthesized the literature relevant to theory and practice for well-being specifically in Women living with HIV (WLWH) aged 50 years and older. Sixteen eligible qualitative studies were critically appraised and thematically synthesized to investigate how aging was perceived to affect well-being in WLWH aged 50 years and older. Six themes demonstrated how HIV-related stigmas negatively affected social well-being, and how adjusting to living and aging with HIV negatively affected psychological and physical well-being of older WLWH. Holding caring roles also negatively affected physical well-being of WLWH. Globally, majority women aging with HIV were found to experience additional stigmas. Further research could elucidate how HIV-related stigma affects the well-being of global majority women living and aging with HIV. Recommendations are made for future HIV-related clinical practice and theory development.
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Affiliation(s)
- Rebecca Conway
- Rebecca Conway, DClinPsy, is a Clinical Psychologist, Affiliated with Royal Holloway, University of London, Surrey, United Kingdom. Michael Evangeli, DClinPsy, is a Clinical Psychologist and Professor of Clinical Psychology at Royal Holloway, University of London, Surrey, United Kingdom
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Scofield D, Weis N, Andersson M, Storgaard M, Pedersen G, Johansen IS, Katzenstein TL, Graugaard C, Frisch M, Moseholm E. Psychosocial, sexual, reproductive and menopausal health in women with and without HIV in a high-income setting. AIDS 2023; 37:1315-1322. [PMID: 36988225 DOI: 10.1097/qad.0000000000003555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To investigate psychosocial, sexual, reproductive and menopausal health in women with HIV (WWH) compared to women without HIV (WWOH) in Denmark. DESIGN A nationwide cross-sectional study. METHODS Data was retrieved from the SHARE study , a Danish nationwide cross-sectional survey examining psychosocial, sexual and reproductive health in people with HIV. Data from WWH, collected in 2021-2022, was matched 1:10 on age to a comparison group of WWOH from the nationally representative cohort study Project SEXUS . Associations between HIV status and psychosocial and sexual health outcomes were assessed by adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs) obtained in logistic regression analyses controlling for potential confounding variables. The severity of menopausal symptoms in WWH was compared to published reference norms. RESULTS Among 144 WWH and 1440 WWOH, recurrent loneliness was significantly more common among WWH (aOR 2.22 [95% CI: 1.25-3.96]), and WWH had significantly fewer children and close friends (aOR 0.52 [95% CI: 0.28-0.96] for 3-9 vs. 0-2 close friends). Symptoms of anxiety and depression did not differ between groups. Lack of sexual desire (aOR 2.90 [95% CI: 1.29-6.50]), low FSFI-6 score indicating sexual dysfunction (aOR 3.40 [95% CI: 1.33-8.69]), lubrication dysfunction (aOR 8.24 [95% CI: 2.83-24.00]) and genital pain dysfunction (aOR 5.13 [95% CI: 1.26-20.86]) were significantly more common in WWH compared to WWOH. No differences were seen in menopausal characteristics. CONCLUSIONS WWH in Denmark have fewer children and close friends, and more often report recurrent loneliness, lacking sexual desire and sexual dysfunction compared to WWOH. No differences were evident in menopausal characteristics.
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Affiliation(s)
- Ditte Scofield
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg
| | - Morten Frisch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Okhai H, Sabin C, Haag K, Sherr L, Dhairyawan R, Shephard J, Richard G, Burns F, Post F, Jones R, Gilleece Y, Tariq S. The Prevalence and Patterns of Menopausal Symptoms in Women Living with HIV. AIDS Behav 2022; 26:3679-3687. [PMID: 35604509 PMCID: PMC9550775 DOI: 10.1007/s10461-022-03696-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Increasing numbers of women with HIV are experiencing menopause. We use data from a large, representative sample of women with HIV to describe the prevalence and clustering of menopausal symptoms amongst pre-, peri- and post-menopausal women using hierarchical agglomerative cluster analysis. Of the 709 women included, 21.6%, 44.9% and 33.6% were pre-, peri- and post-menopausal, respectively. Joint pain (66.4%) was the most commonly reported symptom, followed by hot flashes (63.0%), exhaustion (61.6%) and sleep problems (61.4%). All symptoms were reported more commonly by peri- and post-menopausal women compared to pre-menopausal women. Psychological symptoms and sleep problems clustered together at all menopausal stages. Somatic and urogenital symptom clusters emerged more distinctly at peri- and post-menopause. We recommend regular and proactive assessment of menopausal symptoms in midlife women with HIV, with an awareness of how particular patterns of symptoms may evolve over the menopausal transition.
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Affiliation(s)
- H Okhai
- Institute for Global health, University College London, London, UK.
| | - C Sabin
- Institute for Global health, University College London, London, UK
| | - K Haag
- Institute for Global health, University College London, London, UK
| | - L Sherr
- Institute for Global health, University College London, London, UK
| | - R Dhairyawan
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | | | - G Richard
- Institute for Global health, University College London, London, UK
| | - F Burns
- Institute for Global health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - F Post
- Kings College Hospital NHS Foundation Trust, London, UK
| | - R Jones
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Y Gilleece
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - S Tariq
- Institute for Global health, University College London, London, UK
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King EM, Kaida A, Mayer U, Albert A, Gormley R, de Pokomandy A, Nicholson V, Cardinal C, Islam S, Loutfy M, Murray MCM. Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers. J Acquir Immune Defic Syndr 2022; 89:505-510. [PMID: 34954716 DOI: 10.1097/qai.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group. SETTING This study was conducted across 3 Canadian provinces from 2015 to 2017. METHODS Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications. RESULTS Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]. CONCLUSION Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.
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Affiliation(s)
- Elizabeth M King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
| | - Rebecca Gormley
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | | | - Valerie Nicholson
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
| | - Claudette Cardinal
- Simon Fraser University, Faculty of Health Sciences, Burnaby, British Columbia, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and
| | - Melanie C M Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, British Columbia, Canada
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Chirwa M, Taghinejadi N, Macaulay G, Mandalia S, Bellone C, Panay N, Brum R, Nwokolo N. Reflections on a specialist HIV menopause service. HIV Med 2022; 23:426-433. [DOI: 10.1111/hiv.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Mimie Chirwa
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | | | | | | | - Claire Bellone
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Nicholas Panay
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Roberta Brum
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust London UK
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Haag K, Tariq S, Dhairyawan R, Sabin C, Okhai H, Gilson R, Burns F, Sherr L. Patterns of mental health symptoms among women living with HIV ages 45-60 in England: associations with demographic and clinical factors. Menopause 2022; 29:421-429. [PMID: 35131964 DOI: 10.1097/gme.0000000000001931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to describe the prevalence of various mental health symptoms according to menopausal status (pre, peri, post) among women living with HIV ages 45-60 in England, and to identify groups of women with similar general and menopause-related mental health symptoms. We then investigated demographic predictors of group-membership and group differences in HIV-related care outcomes (antiretroviral therapy adherence, HIV clinic attendance, CD4-count, and last HIV viral load). METHODS An analysis of cross-sectional data from the Positive Transitions through Menopause study, an observational study of the health and well-being impacts of menopause on 869 women with HIV aged 45-60 years. Self-reported data on eight mental health indicators were collected from women in pre-, peri- and post-menopausal state using validated measures. Groups (termed "classes") of women with similar mental health symptoms were derived via latent class analysis. Class membership was linked to demographic factors using nominal logistic regression, and to clinical outcomes using Wald tests. RESULTS We identified five classes: 1) few mental health symptoms (n = 501, 57.8%); 2) high current anxiety/depression (n = 120, 13.8%); 3) history of depression, with elevated current substance use (n = 40, 4.6%); 4) history of depression with current psychological menopause symptoms (n = 81, 9.3%); and 5) high previous and concurrent mental health problems (n = 125, 14.4%). University attendance, ethnicity, and longer time since HIV diagnosis predicted class membership. Antiretroviral therapy adherence was lower in classes 3 (11%), 4 (19%) and 5 (24%) compared to class 1 (4%; all P<0.001). Members of class 5 were more likely to have missed ≥1 HIV clinic appointment in the past year than those in class 1 (34% vs 17%, P = 0.005). CONCLUSIONS Women with a history of depression, current anxiety/depression, and current menopause-related mental health symptoms were more likely to have poorer clinical outcomes. Although we cannot comment on causality, our findings highlight the importance of assessing and managing menopausal symptoms and mental health to improve well-being and engagement in HIV care.
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Affiliation(s)
- Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Rageshri Dhairyawan
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Hajra Okhai
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK; and
- Royal Free London NHS Foundation Trust, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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Okhai H, Sabin CA, Haag K, Sherr L, Dhairyawan R, Burns F, Gilson R, Post F, Ross J, Mackie N, Sullivan A, Shepherd J, Tariq A, Jones R, Fox J, Rosenvinge M, Tariq S. Menopausal status, age and management among women living with HIV in the UK. HIV Med 2021; 22:834-842. [PMID: 34309177 DOI: 10.1111/hiv.13138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is currently little evidence exploring menopausal status, age at last menstrual period (LMP) and management of menopause among women living with HIV aged 45-60 years in England. METHODS Socio-demographic, lifestyle and clinical data were collected through a self-completed cross-sectional survey. Longitudinal CD4 count and viral load data were available from linkage to clinical records, if consent was provided. Women were categorised as pre-, peri- or post-menopausal. Factors associated with menopausal stage were examined using ordinal logistic regression adjusting for age. Age at LMP was estimated using Kaplan-Meier survival analysis. RESULTS The 847 women had a median age of 49 [interquartile range (IQR): 47-52] years. Most were of black ethnicity (81.3%), were born outside the UK (85.0%) and had completed secondary education (88.7%); 177 (20.4%), 373 (43.0%) and 297 (34.2%) were pre-, peri- or post-menopausal, respectively. After adjusting for age, associations of menopausal status with non-cohabiting relationship [adjusted odds ratio = 0.63 (95% confidence interval: 0.43-0.91)], baseline viral load ≥ 100 000 copies/mL [2.67 (1.20-5.94)] and unemployment [1.34 (0.97-1.84)] remained significant. Median (IQR) age at LMP was 54 (51-55) years in the group. In total, 27.9% (233/836) of women reported severe menopausal symptoms; 45.6% of those with somatic symptoms had heard of hormone replacement therapy and 8.7% had used it. Only 5.6% of women with urogenital symptoms had used topical oestrogen. CONCLUSIONS Our findings highlight the importance of educating both women and their healthcare providers about menopausal symptoms and management options.
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Affiliation(s)
- Hajra Okhai
- Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
| | - Katharina Haag
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | | | - Fiona Burns
- Institute for Global Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Frank Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Ann Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Anjum Tariq
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Rachael Jones
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Julie Fox
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Shema Tariq
- Institute for Global Health, University College London, London, UK
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Attitudes toward Menopause in HIV-Infected Cambodian Women. Healthcare (Basel) 2021; 9:healthcare9060677. [PMID: 34200010 PMCID: PMC8226442 DOI: 10.3390/healthcare9060677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: Attitudes toward menopause are believed to play a potential role in the experience of menopause, including its perceived severity. However, the studies available on the perspectives of women living with human immunodeficiency virus (HIV) on menopause in Cambodia are very limited. This study aimed to evaluate the attitudes toward menopause of Cambodian women living with HIV. (2) Methods: A cross-sectional study was conducted among 189 women using a questionnaire titled Attitude toward Menopause Scale and socio-demographics. (3) Results: The study analysis showed that the participants had slightly negative attitudes toward menopause with the mean attitude score of 86.81 ± 10.79 (Range 35–140). Postmenopausal women displayed more positive attitudes than premenopausal women. Older age, higher education, and a non-drinking habit were independently associated with a positive attitude toward menopause. (4) Conclusions: The results suggest the need for a multidisciplinary team of health care experts that would address the special needs of this population marked by the menopausal transition.
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Suarez-García I, Alejos B, Pérez-Elías MJ, Iribarren JA, Hernando A, Ramírez M, Tasias M, Pascual M, Jarrin I, Hernando V. How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort. BMC Womens Health 2021; 21:223. [PMID: 34049547 PMCID: PMC8162006 DOI: 10.1186/s12905-021-01370-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/21/2021] [Indexed: 12/02/2022] Open
Abstract
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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Affiliation(s)
- Ines Suarez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofia, FIIB HUIS HHEN, Madrid, Spain
- Universidad Europea de Madrid, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | | | | | - Asunción Hernando
- Universidad Europea de Madrid, Madrid, Spain
- Instituto de Investigación Hospital Universitario Doce Octubre, Madrid, Spain
| | | | | | - Mario Pascual
- Institute of Health Carlos III, Telemedicine and E-Health Unit, Madrid, Spain
| | - Inma Jarrin
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Victoria Hernando
- National Center for Epidemiology, Institute of Health Carlos III, Avda. Monforte de Lemos, 5, 28029, Madrid, Spain.
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10
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Yang Y, Thapa R, Lewis FM. Using Best-Worst Scaling to Determine the Most Burdensome Menopausal Symptoms in Cambodian Women Living With HIV. J Assoc Nurses AIDS Care 2021; 32:174-187. [PMID: 33449581 DOI: 10.1097/jnc.0000000000000226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT As persons living with HIV live longer, it is important to understand the symptoms experienced by menopausal women living with HIV (WLWH). This study used best-worst scaling (BWS) to determine the menopausal symptoms that are most burdensome for Cambodian WLWH. Participants were asked to rate a list of menopausal symptoms in terms of the most and least burdensome in their lives via BWS. The final analysis included 183 participants, 67 of whom were premenopausal, 47 perimenopausal, and 69 postmenopausal women. Physical and mental exhaustion (mean best-worst score = 319) was rated as the most burdensome symptom, and hot flushes and sweating were the least burdensome (mean best-worst score = -181). The BWS provides information on priorities for the distribution of health care resources. Understanding how Cambodian WLWH prioritize burdensome menopausal symptoms is crucial for choosing the most contextually sensitive method to provide health care services and interventions.
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Affiliation(s)
- Youngran Yang
- Youngran Yang, PhD, MPH, RN, is an Associate Professor, School of Nursing, Research Institute of Nursing Science, Sustainable Development Center, Jeonbuk National University, Jeonju, Korea. Roshna Thapa, MSN, RN, is a Research Assistant, School of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea. Frances Marcus Lewis, PhD, RN, FAAN, is an Endowed Professor in Nursing, Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, Washington, USA
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11
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Raggio G, Goodman G, Robbins GK, Looby SE, Labbe A, Psaros C. Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV. HIV Res Clin Pract 2021; 22:1-13. [PMID: 33616022 DOI: 10.1080/25787489.2021.1883957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. OBJECTIVE Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. METHODS Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40-59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. RESULTS Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. CONCLUSIONS Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.
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Affiliation(s)
- Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,National Center for Weight and Wellness, Washington, DC, USA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sara E Looby
- Metabolism Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Labbe
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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12
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Peters BA, Xue X, Wang Z, Usyk M, Santoro N, Sharma A, Anastos K, Tien PC, Golub ET, Weber KM, Gustafson D, Kaplan RC, Burk R, Qi Q. Menopausal status and observed differences in the gut microbiome in women with and without HIV infection. Menopause 2021; 28:491-501. [PMID: 33438892 PMCID: PMC8068580 DOI: 10.1097/gme.0000000000001730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Gut microbiota respond to host physiological phenomena, yet little is known regarding shifts in the gut microbiome due to menopausal hormonal and metabolic changes in women. HIV infection impacts menopause and may also cause gut dysbiosis. We therefore sought to determine the association between menopausal status and gut microbiome composition in women with and without HIV. METHODS Gut microbiome composition was assessed in stool from 432 women (99 premenopausal HIV+, 71 premenopausal HIV-, 182 postmenopausal HIV+, 80 postmenopausal HIV-) via 16S rRNA gene sequencing. We examined cross-sectional associations of menopause with gut microbiota overall diversity and composition, and taxon and inferred metagenomic pathway abundance. Models were stratified by HIV serostatus and adjusted for age, HIV-related variables, and other potential confounders. RESULTS Menopause, ie post- versus premenopausal status, was associated with overall microbial composition only in women with HIV (permutational MANOVA of Jensen Shannon Divergence: P = 0.01). In women with HIV, menopause was associated with enrichment of gram-negative order Enterobacteriales, depletion of highly abundant taxa within Prevotella copri, and alterations in other low-abundance taxa. Additionally, menopause in women with HIV was associated with enrichment of metagenomic pathways related to Enterobacteriales, including degradation of amino acids and phenolic compounds, biosynthesis of enterobactin, and energy metabolism pathways. Menopause-related differences in some low-abundance taxa were also observed in women without HIV. CONCLUSIONS A changing gut microbiome may be an overlooked phenomenon of reproductive aging in women with HIV. Longitudinal assessments across all reproductive stages are necessary to confirm these findings and identify health implications.
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Affiliation(s)
- Brandilyn A. Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mykhaylo Usyk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California San Francisco, and Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathleen M. Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Santinelli L, Ceccarelli G, Borrazzo C, Innocenti GP, Frasca F, Cavallari EN, Celani L, Nonne C, Mastroianni CM, d'Ettorre G. Sex-related differences in markers of immune activation in virologically suppressed HIV-infected patients. Biol Sex Differ 2020; 11:23. [PMID: 32357901 PMCID: PMC7195770 DOI: 10.1186/s13293-020-00302-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Gender-specific studies remain a neglected area of biomedical research. Recent reports have emphasized that sex-related biological factors may affect disease progression during HIV-1 infection. The aim of this study was to investigate the influence of sex on the levels of immune activation in the gut and in peripheral blood of individuals with HIV treated with fully suppressive antiretroviral therapy (ART). METHODS Thirty individuals with HIV undergoing long-term fully suppressive ART were enrolled in this study. Lamina propria lymphocytes (LPL) and peripheral blood mononuclear cells (PBMCs) were isolated from gut biopsies collected by pancolonoscopy and peripheral blood samples. The expression of markers of immune activation was evaluated by multi-parametric flow cytometry. This is a sub analysis of ClinicalTrials.gov Identifier: NCT02276326 RESULTS: We observed differences in the levels of immune activation in the gut and in PBMCs, with values higher in the gut compartment compared to PBMCs. In addition, we found that the mean value of the levels of immune activation was higher in the women than in the men. Finally, we measured the markers of immune activation by mean relative difference (MRD) and confirmed the higher value in the women. CONCLUSION A significant sex-related difference in the level of immune activation was observed in a population of individuals with HIV on long-term ART. A more complete characterization of these differences may support the introduction of sex-specific approaches in the clinical management of individuals with HIV.
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Affiliation(s)
- Letizia Santinelli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
| | - Cristian Borrazzo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Federica Frasca
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Chiara Nonne
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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14
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Solomon D, Sabin CA, Burns F, Gilson R, Allan S, de Ruiter A, Dhairyawan R, Fox J, Gilleece Y, Jones R, Post F, Reeves I, Ross J, Ustianowski A, Shepherd J, Tariq S. The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV. AIDS Care 2020; 33:101-108. [PMID: 32279528 PMCID: PMC8043570 DOI: 10.1080/09540121.2020.1748559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance. We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression. Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms. Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.
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Affiliation(s)
| | | | - Fiona Burns
- Institute for Global Health, University College London, UK.,Royal Free London NHS Foundation Trust, UK
| | - Richard Gilson
- Institute for Global Health, University College London, UK
| | - Sris Allan
- Coventry and Warwickshire Partnership NHS Trust, UK
| | | | | | - Julie Fox
- Guy's & St Thomas' NHS Foundation Trust, UK
| | - Yvonne Gilleece
- Brighton & Sussex University Hospitals NHS Trust, UK.,Brighton & Sussex Medical School, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, UK
| | - Frank Post
- King's College Hospital NHS Foundation Trust, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, UK
| | - Jonathan Ross
- University Hospital Birmingham NHS Foundation Trust, UK
| | | | | | - S Tariq
- Institute for Global Health, University College London, UK
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15
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Cutimanco-Pacheco V, Arriola-Montenegro J, Mezones-Holguin E, Niño-Garcia R, Bonifacio-Morales N, Lucchetti-Rodríguez A, Ticona-Chávez E, Blümel JE, Pérez-López FR, Chedraui P. Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women. Climacteric 2019; 23:229-236. [PMID: 31809600 DOI: 10.1080/13697137.2019.1664457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection.Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR).Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39-2.29; PR: 1.76, 95% CI: 1.38-2.23; and PR: 2.07, 95% CI: 1.64-2.61, respectively) and the adjusted model.Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.
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Affiliation(s)
- V Cutimanco-Pacheco
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - J Arriola-Montenegro
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Sociedad Nacional de Capacitación (SONACAP), Lima, Peru
| | - E Mezones-Holguin
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Epi-gnosis Solutions, Piura, Peru
| | - R Niño-Garcia
- Epi-gnosis Solutions, Piura, Peru.,Facultad de Ciencias de la Salud, Sociedad Científica de Estudiantes de Medicina (SOCIEMUNP), Universidad Nacional de Piura, Piura, Peru
| | - N Bonifacio-Morales
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
| | - A Lucchetti-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - E Ticona-Chávez
- Departamento de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Peru
| | - J E Blümel
- Facultad de Medicina, Departamento de Medicina Interna Sur, Universidad de Chile, Santiago, Chile
| | - F R Pérez-López
- Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.,Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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16
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In people living with HIV (PLWH), menopause (natural or surgical) contributes to the greater symptom burden in women: results from an online US survey. Menopause 2019; 25:744-752. [PMID: 29509596 DOI: 10.1097/gme.0000000000001083] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The majority of people living with HIV in the United States are now over the age of 50, but symptom burden research has seldom included older women or the potential role of menopause. The aim of the study was to examine the influence of menopause as part of sex differences in HIV symptom burden. METHODS A cross-sectional study was conducted that included both a sex-based analysis of previously reported HIV symptom characteristics of 1,342 respondents to an online survey (males, n = 957; female, n = 385) and a follow-up online survey of menstrual bleeding patterns (inferred menopause) in eligible females (n = 242) from the respondent pool. Using linear mixed models, we identified predictors of symptom burden scores in female respondents. RESULTS For the most troublesome symptoms assessed in the sex-based analysis, depression scores were similar (P > 0.05), but higher (worse) burden scores for fatigue (P = 0.013) and muscle aches/pains (P = 0.004) were exclusively observed in females after adjusting for covariates. Respondents to the female survey (n = 222) were predominantly Black, heterosexual, nonsmokers, and obese, with an HIV diagnosis of approximately 16 years and at least one comorbid condition. Burden scores were higher in women reporting amenorrhea due to natural menopause or hysterectomy (n = 104) versus the menstruating group (n = 118) for muscle aches/pains (P = 0.05), fatigue (P = 0.03), and difficulty falling asleep (P = 0.04), independent of age, HIV duration, and number of HIV-associated non-AIDS conditions. CONCLUSIONS Two of the most common symptoms in people living with HIV-fatigue and muscle aches/joint pains-invoke additional burden in women. Independent of aging, symptom burden may be exacerbated after menopause, supporting a shifting paradigm for HIV care management.
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17
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Schnall R, Jia H, Reame N. Association Between HIV Symptom Burden and Inflammatory Cytokines: An Analysis by Sex and Menopause Stage. J Womens Health (Larchmt) 2019; 29:119-127. [PMID: 31433243 DOI: 10.1089/jwh.2019.7749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: There is a growing body of knowledge characterizing the menopause experience in those with HIV. The primary goal of this study was to assess inflammatory cytokine associations with symptoms and sex-specific differences, and the secondary focus was to assess differences among women by menopause status. Materials and Methods: One hundred persons living with HIV (PLWH) (25 men and 75 women recruited by menopause stage) completed a blood draw for hormones and cytokines and study questions on demographics, height and weight, reproductive health status, HIV symptoms, PROMIS-29 measures, and most recent viral load; study visits were synchronized to the early follicular phase in women with regular cycles. Results: In both sexes, the most burdensome HIV symptoms were muscle aches/joint pain, difficulty falling asleep, fatigue, and neuropathy. Three of the five symptoms where burden scores differed by menopause stage were related to pain with highest scores in the premenopause group; the postmenopause group also demonstrated a similar burden for muscle aches/joint pain while scores for men and perimenopause women were lowest. Pain intensity scores on the PROMIS-29 also varied significantly by groups. After controlling for sex, menopause stage and body mass index, significant differences were noted in C-reactive protein (CRP), interleukin (IL)-6, and IL-8 for PLWH who reported muscle aches/joint pain. Conclusions: Our findings suggest enhanced burden for HIV-related symptoms in women in the early follicular phase, possibly owing to menstruation. This supports the need for more targeted investigations in younger cycling women with HIV at multiple phases across the menstrual cycle. Muscle aches/pain are strongly associated with decreased CRP and IL-8 levels and increased IL-6 levels suggesting the need for further investigation of the biological pathways contributing to pain in PLWH. Finally, there is evidence to support that in PLWH, systemic inflammation is heightened above recommended clinical guidelines even when viral load is undetectable supporting the need for further study of the effects of persistent elevated inflammation on health outcomes.
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Affiliation(s)
| | - Haomiao Jia
- Columbia University, School of Nursing, New York, New York
| | - Nancy Reame
- Columbia University, School of Nursing, New York, New York
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18
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Severe menopausal symptoms associated with reduced adherence to antiretroviral therapy among perimenopausal and menopausal women living with HIV in Metro Vancouver. Menopause 2019; 25:531-537. [PMID: 29206769 DOI: 10.1097/gme.0000000000001040] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Although more women living with HIV (WLWH) are entering midlife, the experiences of perimenopausal and menopausal WLWH, including the effects of menopausal symptoms severity, remain understudied. This study longitudinally investigated the correlates of antiretroviral therapy (ART) adherence among perimenopausal and menopausal WLWH from Metro Vancouver. METHODS Analyses drew on longitudinal data (2014-2017) from Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment, an ongoing community-based cohort of WLWH, aged 14+, from Metro Vancouver, Canada. At baseline and biannually, participants completed an interviewer-administered questionnaire. Bivariate and multivariable logistic regression with generalized estimating equations were used to identify the correlates of self-reported <95% ART adherence. RESULTS The sample included 109 perimenopausal and menopausal WLWH (233 observations), with a median age of 49 years (IQR 44-53). Whereas most (68.8%) participants experienced menopausal symptoms, only 17% had received treatment (eg, antidepressants, hormone therapy) at baseline. In multivariable analysis, severe menopausal symptoms (adjusted odds ratio [AOR] 1.03, 95% confidence interval [CI] 1.00-1.06), injection drug use (AOR 2.86, 95% CI 1.44-5.55), and physical/sexual violence (AOR 2.33, 95% CI 1.02-5.26) independently and positively correlated with <95% adherence. CONCLUSIONS These findings suggest that menopausal symptoms may undermine ART adherence, with overlapping vulnerabilities such as injection drug use and sexual/physical violence further exacerbating poor ART adherence. Women-centred, trauma-informed care approaches to detect menopause and treat menopausal symptoms are urgently needed. Such approaches should holistically address the intersecting barriers to adherence and link WLWH to peripheral health and social services, including trauma counseling and evidence-based harm reduction services.
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19
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Tariq S, Burns FM, Gilson R, Sabin C. PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England. BMJ Open 2019; 9:e025497. [PMID: 31171548 PMCID: PMC6561408 DOI: 10.1136/bmjopen-2018-025497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Advances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related events, including menopause, is of increasing importance in the care of people living with HIV. The PRIME (Positive Transitions Through the Menopause) Study aims to explore the impact of the menopause on the health and well-being of women living with HIV (WLHIV). METHODS AND ANALYSIS The PRIME Study is a multicentre, mixed-methods observational study deploying a multiphase sequential design with explanatory and exploratory phases. Phase 1 comprised three focus group discussions with WLHIV. In phase 2 we aimed to administer questionnaires comprising detailed assessment of menopausal status and symptoms to 1500 WLHIV aged 45-60 attending HIV clinics in England. Phase 3 comprised semistructured interviews with a subsample of phase 2 participants. Ongoing quantitative follow-up of 100 participants is planned between October 2018 and September 2019. Qualitative and quantitative data will be kept analytically distinct and analysed using appropriate methods. We will integrate quantitative and qualitative findings using coding matrices. ETHICS AND DISSEMINATION The PRIME Study has ethical approval from the South East Coast-Surrey Research Ethics Committee on behalf of all National Health Service (NHS) sites, and approval from University College London Research Ethics Committee for qualitative work conducted in non-NHS sites. In conjunction with the study Expert Advisory Group (which includes WLHIV), we have drafted a dissemination strategy that takes into account a wide range of stakeholders, including patients, policy makers and healthcare providers. This includes at least five empirical research papers to be submitted to peer-reviewed journals, as well as an accessible report aimed primarily at a non-technical audience (published in May 2018 and launched at a live-streamed event). Both quantitative and qualitative data are held by the PRIME Study team and are available by request.
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Affiliation(s)
- Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
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20
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Thapa R, Yang Y, Bekemeier B. Menopausal symptoms and associated factors in women living with HIV in Cambodia. J Women Aging 2019; 32:517-536. [PMID: 30957680 DOI: 10.1080/08952841.2019.1593773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study investigated the prevalence and severity of menopausal symptoms and associated factors among women living with HIV in Cambodia. Menopause Rating Scale (MRS) assessed the menopausal symptoms, and SPSS Version 20.0 analyzed the data. The three most dominant symptoms, which were also rated the top three "severe" symptoms, were psychological: physical and mental exhaustion (91.5%), irritability (84.1%), and depressive mood (83.6%). The highest incidence was among the perimenopausal women. Severity of symptoms was associated with personal income, abortion, and intake of calcium supplements. Health-care professionals need to provide appropriate individualized interventions to maintain the social, emotional, and overall well-being of menopausal women living with HIV.
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Affiliation(s)
- Roshna Thapa
- School of Nursing, Chonbuk National University , Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Youngran Yang
- School of Nursing, Research Institute of Nursing Science, Chonbuk National University , Jeonju-si, Jeollabuk-do, Republic of Korea
| | - Betty Bekemeier
- School of Nursing, University of Washington , Seattle, Washington, USA
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21
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Howells P, Modarres M, Samuel M, Taylor C, Hamoda H. Experience of hormone replacement therapy in postmenopausal women living with HIV. Post Reprod Health 2019; 25:80-85. [PMID: 30895862 DOI: 10.1177/2053369119838737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the uptake of hormone replacement therapy in women living with HIV (WLHIV) in particular acceptability, response to treatment and compliance. Study design Retrospective review of menopausal women attending a HIV medical gynaecology clinic in a tertiary referral London Hospital between 1 January 2011 and 31 December 2016. Main outcome measures Patient demographics, presenting symptoms, uptake of hormone replacement therapy, type of hormone replacement therapy used and bone density assessment findings at presentation. Results Seventy-three HIV patients were evaluated. Of them 64 (87%) were of black ethnicity and 9 (13%) were of white ethnicity. The commonest presenting complaints were vasomotor symptoms (40/73, (55%)) followed by low mood/irritability (20/73, (27%)). When offered hormone replacement therapy, this was accepted by 28/53 (52%) in WLHIV. The commonest regimen prescribed was transdermal oestradiol/micronised progesterone. A total of 22/24 (91%) women of black ethnicity reported good symptom control if they had started hormone replacement therapy, with 4/24 (17%) subsequently discontinuing it; 3/4 (75%) of white women reported good symptom control with hormone replacement therapy, with no one discontinuing it. The commonest reason for discontinuation was irregular bleeding. Of WLHIV who had a bone density assessment, 15/25 (60%) had osteopenia while 2/25 (8%) had osteoporosis. Conclusion Our data show that only around 50% WLHIV accepted hormone replacement therapy when offered and a high proportion of these women discontinued it. Further research is needed to explore the reason leading to low uptake and high rates of stopping hormone replacement therapy. In addition, there is a need to increase awareness of the benefits of hormone replacement therapy in WLHIV both in the context of preventing osteoporosis and menopausal symptom management.
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Affiliation(s)
- P Howells
- 1 Department of Obstetrics and Gynaecology, Kings College Hospital, NHS Foundation Trust, London
| | - M Modarres
- 1 Department of Obstetrics and Gynaecology, Kings College Hospital, NHS Foundation Trust, London
| | - M Samuel
- 2 Department of Sexual Health and HIV, Kings College Hospital, NHS Foundation Trust, London
| | - C Taylor
- 2 Department of Sexual Health and HIV, Kings College Hospital, NHS Foundation Trust, London
| | - H Hamoda
- 1 Department of Obstetrics and Gynaecology, Kings College Hospital, NHS Foundation Trust, London
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22
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Cejtin HE, Evans CT, Greenblatt R, Minkoff H, Weber KM, Wright R, Colie C, Golub E, Massad LS. Prolonged Amenorrhea and Resumption of Menses in Women with HIV. J Womens Health (Larchmt) 2018; 27:1441-1448. [PMID: 30222490 PMCID: PMC6306666 DOI: 10.1089/jwh.2018.7046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To compare etiologies of prolonged amenorrhea in a cohort of HIV-infected women with a cohort of similar uninfected at-risk women. MATERIALS AND METHODS Women from the Women's Interagency HIV Study were seen every 6 months, and completed surveys including questions about their menstruation. Those who reported no vaginal bleeding for at least 1 year ("prolonged amenorrhea") with subsequent resumption of bleeding were compared with women in whom bleeding had stopped permanently ("menopause"). Characteristics associated with reversible prolonged amenorrhea were ascertained. RESULTS Of 828 women with prolonged amenorrhea, 37.6% had reversible amenorrhea and 62.4% never resumed menses. HIV-seropositive women with prolonged amenorrhea were significantly younger at cessation of menses than HIV-negative women (p < 0.0001). Of those with reversible prolonged amenorrhea, approximately half were taking medications associated with amenorrhea, including 95 (30.6%) hormonal contraception, 80 (25.7%) opiates/stimulants, 16 (5.1%) psychotropic medications, and 6 (1.9%) chemotherapy. HIV-seropositive women were less likely to have medications as a cause of amenorrhea than seronegative women (p = 0.02). In multivariable analysis, women with reversible prolonged amenorrhea of unknown etiology were younger (p < 0.0001), more often obese (p = 0.03), and less educated (p = 0.01) than those with permanent amenorrhea. Among HIV-seropositive women, markers of severe immunosuppression were not associated with prolonged amenorrhea. CONCLUSION Women with HIV infection have unexplained prolonged amenorrhea more often than at-risk seronegative women. This is especially common among obese, less-educated women. Prolonged amenorrhea in the HIV-seropositive women should be evaluated and not be presumed to be to the result of menopause.
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Affiliation(s)
- Helen E. Cejtin
- Department of Obstetrics and Gynecology, John H. Stroger Jr. Hospital of Cook County, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Charlesnika T. Evans
- Department of Preventive Medicine and Center for Healthcare Studies Northwestern University and Department of Veterans Affairs, Chicago, Illinois
| | - Ruth Greenblatt
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, New York, New York
| | - Kathleen M. Weber
- Cook County Health and Hospitals System/Hektoen Institute of Medicine Chicago, Illinois
| | - Rodney Wright
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York
| | - Christine Colie
- Department of Obstetrics and Gynecology, Georgetown University, District of Columbia, Washington
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - L. Stewart Massad
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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23
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Knudsen A, Thorsteinsson K, Christensen TE, Hasbak P, Ripa RS, Panum I, Lebech AM, Kjaer A. Cardiac Microvascular Dysfunction in Women Living With HIV Is Associated With Cytomegalovirus Immunoglobulin G. Open Forum Infect Dis 2018; 5:ofy205. [PMID: 30214912 PMCID: PMC6132927 DOI: 10.1093/ofid/ofy205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/04/2018] [Indexed: 01/09/2023] Open
Abstract
Background People living with HIV (PLWH) appear to be at increased risk of cardiovascular disease (CVD), and this is possibly more pronounced in women living with HIV (WLWH). In the general population, men are more likely to develop obstructive coronary artery disease (CAD), and women often present with a nonobstructive pattern with cardiac microvascular dysfunction. We investigated cardiac microvascular function in men and women living with HIV and tested for association with cytomegalovirus (CMV) immunoglobulin G (IgG), as this has been associated with CVD in PLWH. Methods In a cross-sectional study, 94 PLWH on antiretroviral therapy were scanned with 82Rb positron emission tomography/computed tomography at rest and during adenosine-induced stress, which enables the quantification of the myocardial flow reserve (MFR). CMV IgG was measured in plasma. Results WLWH had significantly lower MFR compared with men living with HIV (MLWH; P = .003), and >45% of the women had an MFR indicative of cardiac microvascular dysfunction, whereas this was only true for 24% of men (P = .03). CMV IgG concentrations were inversely associated with MFR among WLWH but not MLWH (P = .05 for interaction). Conclusions In this first study comparing MFR in women and men living with HIV, we found that WLWH had significantly lower MFR than MLWH and 45% of the women had cardiac microvascular dysfunction despite younger age and lower cardiovascular risk. Furthermore, CMV IgG was inversely associated with MFR among women but not men. This calls for attention to CVD among young WLWH even with low cardiovascular risk.
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Affiliation(s)
- Andreas Knudsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas E Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Sejersten Ripa
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Inge Panum
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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25
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Adam GP, Di M, Cu-Uvin S, Halladay C, Smith BT, Iyer S, Trikalinos TA. Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map. Syst Rev 2018; 7:25. [PMID: 29391059 PMCID: PMC5796491 DOI: 10.1186/s13643-018-0684-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While in its early years the HIV epidemic affected primarily the male and the young, nowadays, the population living with HIV/AIDS is approximately 24% women, and its age composition has shifted towards older ages. Many of the older women who live with HIV/AIDS also live with the medical and social conditions that accompany aging. This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Forty was chosen as an operational age cutoff to identify premenopausal women who are less likely to bear children, as well as peri- and postmenopausal women. METHODS We conducted a literature search after discussions with a diverse panel of content experts and other stakeholders and developed an evidence map that identified 890 citations that address questions having to do with programs and barriers to engaging with programs, as well as the role of insurance and comorbidities, and have enrolled older women who live with HIV/AIDS. RESULTS Of these, only 37 (4%) reported results of interest for women over 40 who live with HIV/AIDS, or examined interactions between gender and older age that would allow predictions in this subgroup. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40. CONCLUSION The evidence base that is directly applicable to women over 40 who live with HIV/AIDS in the USA is limited, and the research need is broad. We propose research prioritization strategies for this population.
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Affiliation(s)
- Gaelen P Adam
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Mengyang Di
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Susan Cu-Uvin
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.,Department of Ob-Gyn and Medicine, Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Halladay
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Bryant T Smith
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Suchitra Iyer
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Thomas A Trikalinos
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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26
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Solomon D, Sabin CA, Mallon PW, Winston A, Tariq S. Cardiovascular disease in women living with HIV: A narrative review. Maturitas 2018; 108:58-70. [DOI: 10.1016/j.maturitas.2017.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 12/14/2022]
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27
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Abstract
Effective antiretroviral therapy has resulted in a close to normal life expectancy for people living with HIV. This has led to a shift in the age distribution of women living with HIV in the UK, with one in three attending for HIV care estimated to be aged 45-56 years in 2014. The lack of experience of many HIV physicians in managing menopause, and the perceived complexity of managing menopause in women living with HIV by general practitioners means that many women are unable to access appropriate care and support. This is aggravated by the relative paucity of data on menopause in women living with HIV and conflicting results in this field, for example with regard to age of onset of menopause and symptomatology experienced. Furthermore, women living with HIV have unique considerations such as potential interactions between antiretroviral therapy and menopause hormone therapy (previously called hormone replacement therapy) and other physiological concerns such as a multifactorial propensity towards decreased bone mineral density and potentially increased cardiovascular risk. On the whole, menopause hormone therapy is probably underutilised in this group of women due to perceived concerns around drug-drug interactions, as well as fears shared with women in the general population about menopause hormone therapy. Menopausal women should be given adequate information on symptomatology, lifestyle modification and treatment options including menopause hormone therapy. Furthermore, a holistic approach which considers the increased burden of poor mental health in this population is essential.
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Affiliation(s)
- Lauren Bull
- 9762 Chelsea and Westminster Hospital , London, UK
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28
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Chirwa M, Ma R, Guallar C, Tariq S. Managing menopause in women living with HIV: A survey of primary care practitioners. Post Reprod Health 2017. [PMID: 28629256 PMCID: PMC5613803 DOI: 10.1177/2053369117712181] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective One in three women living with HIV (WLHIV) in the UK is aged 45–56, and therefore of potentially menopausal age. Little is known about the management of menopause in WLHIV in primary care. We aim to describe current knowledge and practice in the management of menopause in WLWH among primary care practitioners (PCPs). Methods A questionnaire-based study of 88 PCPs attending two sexual and reproductive health conferences. Results Almost all respondents (n = 87, 99%) routinely managed women with menopause-related symptoms; however, only 18 (20%) reported having managed menopause in WLHIV. Over 95% (n = 85) reported being confident in managing menopause in general, whereas less than half (n = 40) reported confidence in managing menopause in WLHIV (p < 0.001). The majority of respondents (n = 84) felt that menopause should be routinely managed in primary care, whereas just over half thought that menopause in WLHIV should be managed in primary care (n = 50, p < 0.001). Almost all respondents (n = 85) reported concerns about managing menopause in WLHIV. Conclusion PCPs reported limited experience of and low levels of confidence in managing menopause-related symptoms in WLHIV. Nearly all PCPs had concerns about managing menopause-related symptoms in WLHIV, many stating that this should be managed outside primary care. Development of national guidance and specialised training, coupled with good liaison between HIV services and PCPs, may improve confidence in this area.
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Affiliation(s)
| | | | | | - Shema Tariq
- 3 Mortimer Market Centre, UK.,4 University College London, London, UK
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29
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Monteiro F, Canavarro MC, Pereira M. Prevalence and correlates of psychological distress of middle-aged and older women living with HIV. PSYCHOL HEALTH MED 2017; 22:1105-1117. [PMID: 28100062 DOI: 10.1080/13548506.2017.1281972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aims of this study were to examine the prevalence and correlates of psychological distress among older women living with HIV in comparison to their male counterparts and younger women and to identify the sociodemographic and disease-related factors associated with psychological distress. The sample consisted of 508 HIV-infected patients (65 older women, 323 women aged below 50 years, and 120 older men) recruited from 10 Portuguese hospitals. Data regarding psychological distress were collected using the Brief Symptom Inventory (BSI). Seven older women (10.8%), eight older men (6.7%), and 61 younger women (18.9%) reported a T-score ≥ 63 for global severity index (GSI), indicative of a need for further psychological evaluation. Overall, younger women reported significantly higher psychological distress than older men. The odds of having clinically significant psychological distress score were significantly lower for older women reporting sexual transmission, while for younger women, having other co-infections was a significant correlate of higher psychological distress. Younger women were 2.67 (95% CI: 1.22-5.84) times more likely to report psychological distress than were older men. The odds were not significantly different from older women. This study shows that older women do not differ substantially from younger women and older men in terms of psychological distress. The results reinforce, however, that mental health interventions should be tailored to reflect individuals' circumstances as well as developmental contexts. Moreover, they draw attention to the importance of examining resilience characteristics in older adults to understand the mechanisms behind 'successful ageing' while living with HIV.
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Affiliation(s)
- Fabiana Monteiro
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
| | | | - Marco Pereira
- a Faculty of Psychology and Educational Sciences , University of Coimbra , Coimbra , Portugal
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30
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Abstract
The widespread availability of effective antiretroviral therapy (ART) has transformed HIV from a life-limiting condition to one with near-normal life expectancy. HIV is associated with an increased risk of osteopenia and osteoporosis, with people living with HIV (PLHIV) potentially experiencing these conditions at a younger age than their HIV-negative counterparts. The mechanisms driving bone disease in HIV are complex and include: an increased prevalence of traditional risk factors; other comorbid conditions; and HIV-associated factors such as viral effects, systemic inflammation, and ART-related factors. One-third of PLHIV in the United Kingdom are female, and increasing numbers of women living with HIV (WLHIV) are reaching menopausal age. Oestrogen decline in the context of an elevated background risk of poor bone health results in WLHIV being at greater risk of osteoporosis than women without HIV. European HIV guidelines therefore recommend routine screening of postmenopausal WLHIV using FRAX© for clinical risk factors, with or without bone mineral density scanning. Data support the use of calcium and vitamin D supplementation, and bisphosphonates in the treatment of osteoporosis in PLHIV. Additionally, some patients with confirmed osteoporosis may benefit from a switch to an ART agent with a better bone safety profile. However, there remains a notable paucity of data on HIV and menopause, including the impact of hormone replacement therapy on the bone health of WLHIV. In conclusion, it is important that clinicians are aware that postmenopausal WLHIV are a group at particular risk of bone disease, who require proactive screening and advice about preventative measures.
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31
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Sherr L, Molloy A, Macedo A, Croome N, Johnson M. Ageing and menopause considerations for women with HIV in the UK. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30874-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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