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Gianella S, Rawlings SA, Dobrowolski C, Nakazawa M, Chaillon A, Strain M, Layman L, Caballero G, Scully E, Scott B, Pacis C, Weber KM, Landay A, Anderson C, Karn J. Sex Differences in Human Immunodeficiency Virus Persistence and Reservoir Size During Aging. Clin Infect Dis 2022; 75:73-80. [PMID: 34612493 PMCID: PMC9402699 DOI: 10.1093/cid/ciab873] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sex differences in human immunodeficiency virus (HIV) reservoir dynamics remain underexplored. METHODS Longitudinal samples from virally suppressed midlife women (n = 59, median age 45 years) and age-matched men (n = 31) were analyzed retrospectively. At each time point, we measured sex hormones (by means of enzyme-linked immunosorbent assay) and cellular HIV DNA and RNA (by means of digital droplet polymerase chain reaction). Number of inducible HIV RNA+ cells, which provides an upper estimate of the replication-competent reservoir, was quantified longitudinally in a different subset of 14 women, across well-defined reproductive stages. Mixed-effects models included normalized reservoir outcomes and sex, time since antiretroviral therapy (ART) initiation, and the sex-by-time interaction as predictors. RESULTS At ART initiation, women and men had median (interquartile range [IQR]) CD4+ T-cell counts of 204/μL (83-306/μL) versus 238/μL (120-284/μL), respectively; median ages of 45 (42-48) versus 47 (43-51) years; and median follow-up times of 79.2/μL (60.5-121.1/μL) versus 66.2/μL (43.2-80.6/μL) months. We observed a significant decline of total HIV DNA over time in both men and women (P < .01). However, the rates of change differed significantly between the sexes (P < .01), with women having a significantly slower rate of decline than men, more pronounced with age. By contrast, the levels of inducible HIV RNA increased incrementally over time in women during reproductive aging (P < .01). CONCLUSIONS In contrast to men, in whom the HIV reservoir steadily declines with aging, the HIV reservoir in women is more dynamic. Total HIV DNA (including intact and defective genomes) declines more slowly in women than in men, while the inducible HIV RNA+ reservoir, which is highly enriched in replication-competent virus, increases in women after menopause.
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Affiliation(s)
- Sara Gianella
- University of California San Diego, La Jolla, California, USA
| | | | - Curtis Dobrowolski
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory School of Medicine, Atlanta, Georgia, USA
| | - Masato Nakazawa
- University of California San Diego, La Jolla, California, USA
| | | | - Matthew Strain
- University of California San Diego, La Jolla, California, USA
| | - Laura Layman
- University of California San Diego, La Jolla, California, USA
| | - Gemma Caballero
- University of California San Diego, La Jolla, California, USA
| | | | - Brianna Scott
- University of California San Diego, La Jolla, California, USA
| | - Caitleen Pacis
- University of California San Diego, La Jolla, California, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine/Cook County Health, Chicago, Illinois, USA
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois, USAand
| | | | - Jonathan Karn
- Case Western Reserve University, Cleveland, Ohio, USA
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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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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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Prevalence and correlates of early-onset menopause among women living with HIV in Canada. ACTA ACUST UNITED AC 2021; 27:66-75. [PMID: 31688411 DOI: 10.1097/gme.0000000000001423] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Menopause is a pivotal transition for women. Previous studies have suggested increased risk of early menopause (40-45 years) and premature menopause (<40 years) for women with HIV. We aimed to determine age of menopause, prevalence of early menopause and premature menopause, and risk factors for menopause <45 years in Canadian women with HIV. METHODS This was a cross-sectional analysis from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study. Analyses were restricted to biologically female participants reporting being postmenopausal (regardless of etiology). Primary outcome was median age at menopause. Predetermined variables, and those with P < 0.10 in univariable analyses were considered for inclusion into multivariable logistic regression model, to determine independent correlates of menopause <45 years. RESULTS 229 women were included. Median age of menopause was 48 years (interquartile range 43, 51); 29.7% of women experienced menopause <45 years: 16.6% with early menopause and 13.1% with premature menopause. In univariable analyses, menopause <45 years was more likely (P < 0.05) with birth in Canada, white ethnicity, less than high-school education, smoking, recreational drug use, and hepatitis C co-infection. In multivariable modeling, less than high-school education (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.93) and hepatitis C co-infection (aOR 1.90, 95% CI 1.04-3.50) were independently associated with menopause <45 years. CONCLUSIONS In Canadian women with HIV, median age of menopause was 48 years; 3 years younger than the general population. Only lower education and hepatitis C co-infection were independently associated with menopause <45 years, highlighting importance of socioeconomic factors and comorbidities. These findings have implications for counseling and management of women with HIV.
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Ahmed M, Bondje S, Jiwan R, Rawther F, Duku A, Husain N, Woodward C, Mital D. Early menopause in acquired immunodeficiency syndrome. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:122. [PMID: 35126585 PMCID: PMC8772509 DOI: 10.4103/jrms.jrms_691_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/10/2020] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
Premature menopause can occur in women living with human HIV. In this study, we analyzed and reviewed published literature using the PubMed, Cochrane, and Embase databases since the year 1990 using a combination of MeSH terms such as “Early,” “Premature,” “Menopause,” “HIV,” and “Hormones.” Monitoring and implementation of targeted interventions for premature or early menopause among HIV-infected women might prevent or delay complications such as osteoporosis, cardiovascular diseases, and mental health issues.
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Alejos B, Suárez-García I, Bernardino JI, Blanco JR, Peñaranda M, Bautista A, Gutiérrez F, Jarrín I, Hernando V. Effectiveness and safety of antiretroviral treatment in pre- and postmenopausal women living with HIV in a multicentre cohort. Antivir Ther 2021; 25:335-340. [PMID: 33470219 DOI: 10.3851/imp3380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare effectiveness and safety of initial antiretroviral therapy (ART) among premenopausal and postmenopausal women living with HIV aged 45-60 years from the cohort of the Spanish HIV/AIDS Research Network (CoRIS) who initiated ART between 2004 and 2015. METHODS Multivariable regression models were used to compare post- versus premenopausal women regarding viral suppression (≤50 copies/ml), change in CD4+ T-cell count and time to treatment change (TC) at 48 and 96 weeks after ART initiation. RESULTS Among 230 women, 154 (67%) were premenopausal at ART initiation. The most frequent initial regimen was tenofovir disoproxil fumarate/emtricitabine/efavirenz prescribed in 49 (32%) premenopausal and 22 (29%) postmenopausal women. The proportion of TC was 35.7% and 30.3% at 48 weeks and 51.3% and 47.4% at 96 weeks, for pre- and postmenopausal women, respectively. There were no significant differences in CD4+ T-cell count changes from ART initiation, viral load suppression, time to TC or reason for TC between both groups. The main reason for TC was occurrence of an adverse event, followed by simplification, in both groups. CONCLUSIONS ART effectiveness and safety did not differ significantly between pre- and postmenopausal women.
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Affiliation(s)
- Belén Alejos
- AIDS Research Network, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Inés Suárez-García
- Department of Internal Medicine, Infectious Diseases Group, Hospital Universitario Infanta Sofia, FIIB HUIS HHEN, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | | | - José Ramón Blanco
- Department of Infectious Diseases, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Maria Peñaranda
- Department of Infectious Diseases, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Azucena Bautista
- Department of Infectious Diseases, Hospital Universitario La Princesa, Madrid, Spain
| | - Félix Gutiérrez
- Department of Internal Medicine, Hospital General Universitario de Elche, Elche, Spain
| | - Inma Jarrín
- AIDS Research Network, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Victoria Hernando
- HIV Surveillance Unit, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
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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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8
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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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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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Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
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Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
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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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12
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Tracy LA, Struble K, Firnhaber C, Smeaton L, Lake JE, Bell T, Soon GG, Yan J, Schnippel K, Cohn SE. Age Differences by Sex in Antiretroviral-Naïve Participants: Pooled Analysis from Randomized Clinical Trials. J Assoc Nurses AIDS Care 2018; 29:371-382. [PMID: 29475784 DOI: 10.1016/j.jana.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
Age and sex effects on antiretroviral therapy (ART) response are not well elucidated. Our pooled analysis of 40 randomized clinical trials measured the association of age and sex on CD4+ T cell count changes and virologic suppression using multivariable regression modeling. The average increase in CD4+ T cell count from baseline to week 48 was 17.3 cells/mm3 lower and clinically insignificant (95% confidence interval -30.8 to -3.8) among women ages ≥ 50 years (n = 573), compared to women ≤ 35 years (n = 3,939). Results were similar for men. Virologic suppression odds were 60% and 21% times greater among participants ≥50 years compared to ≤35 years, in women and men, respectively. In both sexes, larger increases in CD4+ T cell count changes were observed in younger, compared to older, participants; however, virologic suppression was higher in older, compared to younger, participants suggesting a non-sex-specific age effect response to ART.
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13
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Wolf E, Hammond A. [In Process Citation]. MMW Fortschr Med 2018; 157 Suppl 2:29-33. [PMID: 26048117 DOI: 10.1007/s15006-015-3163-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eva Wolf
- MVZ Karlsplatz, Karlsplatz (Stachus) 8, D-80335, München, Deutschland,
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14
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Landolt NK, Do T, Kasipong N, Kriengsinyot R, Ubolyam S, Mahanontharit A, Pankam T, Apornpong T, Avihingsanon A, Ananworanich J, Phanuphak N, Chaithongwongwatthana S. Low-level genital HIV shedding in Thai HIV-infected women with suppressed plasma viral load after menopause: a longitudinal study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Kruger MJ, Nell TA. Bone mineral density in people living with HIV: a narrative review of the literature. AIDS Res Ther 2017; 14:35. [PMID: 28747190 PMCID: PMC5530558 DOI: 10.1186/s12981-017-0162-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/21/2017] [Indexed: 02/07/2023] Open
Abstract
Bone health status is largely absent in South Africa, the main reasons being the absence and cost-effectiveness of specific screening equipment for assessing bone mineral density (BMD). Various risk factors seem to play a role, some of which can be modified to change bone health status. Urbanisation is also a public health concern. Changing nutritional, as well as social behaviour, play integral roles in the prevalence and incidence of decreased BMD. Furthermore, human immunodeficiency virus (HIV) specifically, has a negative impact on BMD and although highly active antiretroviral therapy increases the prognosis for HIV-infected individuals, BMD still seem to decrease further. Dual energy X-ray absorptiometry is considered the gold standard for BMD assessment; however, recent developments have provided more cost-effective screening methods, among which heel quantitative ultrasound appears to be the most widely used in resource limited countries such as South Africa.
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16
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Blanco JR, Jarrin I, Pérez-Elías MJ, Gutiérrez F, Hernández-Quero J, Portilla J, Dalmau D, Moreno S, Hernando V. Combined effect of sex and age in response to antiretroviral therapy in HIV-infected patients. Antivir Ther 2016; 22:21-29. [PMID: 27467968 DOI: 10.3851/imp3071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gender-specific data on the management of HIV infection are scarce. Further, an increase in the proportion of new HIV diagnoses in older persons has been observed. Using data from the CoRIS cohort, we compared immunovirological responses and survival in HIV-infected men and women who started their first combination antiretroviral therapy (cART) when aged < /≥50 years. METHODS We used multivariable logistic, linear and Cox regression, adjusting for potential confounders and including an interaction between age and sex, to assess differences in immunovirological responses and mortality, respectively. RESULTS At 96 weeks, among subjects <50 years, women were less likely than men to achieve virological response (VR; adjusted OR [aOR] 0.77, 95% CI 0.60, 0.99) and among women, older individuals were more likely to achieve VR than the younger ones (aOR 1.96; 95% CI 1.15, 3.34). Initiating cART at ≥50 years was associated with lower increases in CD4+ T-cell count both in men (-65.8; 95% CI -91.3, -40.3) and women (-37.7; 95% CI -79.7, 4.4) and women showed higher increases than men in both subjects aged <50 (21.8; 95% CI -1.9, 45.5) and ≥50 years at cART initiation (49.9; 95% CI 19.9, 79.9). A higher risk of death in men ≥50 was observed (adjusted hazard ratio [aHR] 2.69; 95% CI 1.73, 4.21), but not in women (aHR 1.49; 95% CI 0.70, 1.14). Women experienced lower mortality than men <50 (0.66; 95% CI 0.41, 1.07) and in those ≥50 (0.37; 95% CI 0.14, 0.93). CONCLUSIONS Sex and age at cART initiation have a noticeable association with both virological and immunological responses and mortality. Age ≥50 is associated with poorer immunological response and higher mortality but this effect is less pronounced in women than in men.
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Affiliation(s)
| | - Inma Jarrin
- Red de Investigación en SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Félix Gutiérrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | | | | | - David Dalmau
- Hospital Universitari MutuaTerrasa, Terrasa, Spain
| | | | - Victoria Hernando
- Red de Investigación en SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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17
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Quiros-Roldan E, Raffetti E, Focà E, Brianese N, Ferraresi A, Paraninfo G, Pezzoli MC, Bonito A, Magoni M, Scarcella C, Castelli F. Incidence of cardiovascular events in HIV-positive patients compared to general population over the last decade: a population-based study from 2000 to 2012. AIDS Care 2016; 28:1551-1558. [PMID: 27321070 DOI: 10.1080/09540121.2016.1198750] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiovascular diseases are currently a main cause of death among people living with HIV. This population-based study aimed to investigate the incidence of cardiovascular events (CVEs) in HIV-positive people and factors associated with CVEs. We performed a retrospective cohort study of the HIV-infected patients residing in the Local Health Authority of Brescia, northern Italy, from 2000 to 2012. Incidence of CVEs events in HIV-positive patients was compared with that expected in general population living in the same area, computing standardized incidence ratios (SIRs). CVEs-associated risk factors were assessed using Cox regression analysis and competing risk model of death. About 3766 HIV-infected patients were included in the study. Over the 12-year-period, we recorded 134 CVEs: 83 (61.9%) acute myocardial infarctions (CVE type-1), and 51 (38.1%) strokes (CVE type-2). A twofold increased risk (SIR = 2.02) of CVEs was found in HIV-infected patients compared to the general population. Notably, within male patients: for CVE type-1, SIR = 1.89, for CVE type-2 SIR = 2.25; within female patients: for CVE type-1, SIR = 2.91, for CVE type-2 SIR = 2.07. Age >45 years, male gender, diabetes, and total blood cholesterol >200 mg/dl were significantly associated with CVEs incidence (for all, p < .05). These results were confirmed using the competing risk model. Our cohort study confirmed the higher incidence of CVEs in HIV-positive patients, and put emphasis on the importance of traditional cardiovascular risk factors. Overall CVE risk in HIV-positive patients was twice as high as CVE risk in general population. We found a peculiar gender distribution, with a relative risk for CVE type-1 higher in HIV-positive females, and a higher CVE type-2 risk in male patients. More studies are needed in order to support these findings and to further highlight possible gender differences in the risk of developing CVEs in HIV-positive patients.
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Affiliation(s)
- Eugenia Quiros-Roldan
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Elena Raffetti
- b Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology and Public Health , University of Brescia , Brescia , Italy
| | - Emanuele Focà
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Nigritella Brianese
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Alice Ferraresi
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Giuseppe Paraninfo
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Maria Chiara Pezzoli
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Andrea Bonito
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
| | - Michele Magoni
- c Local Health Agency of the Brescia Province , Brescia , Italy
| | | | - Francesco Castelli
- a Department of Clinical and Experimental Sciences, Clinic of Infectious and Tropical Diseases , University of Brescia , Brescia , Italy
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18
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Abstract
Since the implementation of effective combination antiretroviral therapy, HIV infection has been transformed from a life-threatening condition into a chronic disease. As people with HIV are living longer, aging and its associated manifestations have become key priorities as part of HIV care. For women with HIV, menopause is an important part of aging to consider. Women currently represent more than one half of HIV-positive individuals worldwide. Given the vast proportion of women living with HIV who are, and will be, transitioning through age-related life events, the interaction between HIV infection and menopause must be addressed by clinicians and researchers. Menopause is a major clinical event that is universally experienced by women, but affects each individual woman uniquely. This transitional time in women's lives has various clinical implications including physical and psychological symptoms, and accelerated development and progression of other age-related comorbidities, particularly cardiovascular disease, neurocognitive dysfunction, and bone mineral disease; all of which are potentially heightened by HIV or its treatment. Furthermore, within the context of HIV, there are the additional considerations of HIV acquisition and transmission risk, progression of infection, changes in antiretroviral pharmacokinetics, response, and toxicities. These menopausal manifestations and complications must be managed concurrently with HIV, while keeping in mind the potential influence of menopause on the prognosis of HIV infection itself. This results in additional complexity for clinicians caring for women living with HIV, and highlights the shifting paradigm in HIV care that must accompany this aging and evolving population.
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Affiliation(s)
- Nisha Andany
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - V Logan Kennedy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Muna Aden
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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19
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Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review. J Assoc Nurses AIDS Care 2015; 26:387-98. [PMID: 26066693 DOI: 10.1016/j.jana.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/31/2015] [Indexed: 01/28/2023]
Abstract
With the development of effective antiretroviral therapy, HIV-infected women are living longer and transitioning through menopause. The purpose of our study was to systematically examine the evidence that menopause is an additional risk predictor for osteoporosis and fractures in HIV-infected women. Electronic databases were searched for studies of low bone density or fractures in HIV-infected postmenopausal women. Studies that met the inclusion criteria (n = 10) were appraised using a validated quality assessment tool. The majority of studies were rated as good quality and the remaining were fair. The prevalence of osteoporosis reported in these studies ranged from 7.3% to 84% and 0.7% to 23% in HIV-infected and uninfected postmenopausal women, respectively. In the two qualifying studies, postmenopausal status was not a predictor of fractures in HIV-infected women. Findings suggest that HIV care providers should accurately assess postmenopausal status and modifiable risk factors for osteoporosis in all older HIV-infected women.
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20
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Nasta P, Maida I, Cattelan AM, Pontali E, Angeli E, Giralda M, Verucchi G, Caputo A, Iannacone C, Puoti M, Carosi G. Effect of aging, glucose level, and HIV viral load on response to treatment with pegylated interferon plus ribavirin in HIV/HCV co-infected women. J Womens Health (Larchmt) 2015; 24:159-64. [PMID: 25682817 DOI: 10.1089/jwh.2014.4796] [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: 11/12/2022] Open
Abstract
BACKGROUND This was a post-hoc analysis of the Optimized Pegylated interferons Efficacy and anti-Retroviral Approach (OPERA) study, originally designed to document routine clinical and treatment data in HIV/HCV coinfected patients treated with pegylated interferon/ribavirin (PEG-IFN/RBV). The aim of this study was to define the impact of several variables, such as age, glucose metabolism, and HIV viral load, on PEG-IFN/RBV treatment outcomes, in HIV/HCV coinfected women. METHODS Female subjects from the OPERA database were retrospectively evaluated and factors associated with sustained virological response (SVR) were assessed and compared to the male population by logistic regression analysis. At baseline, clinical and demographic data were collected. Patients were then administered with PEG-IFN/RBV therapy for 48 weeks. After a 24-week follow-up period, SVR was evaluated. RESULTS A total of 1523 patients were enrolled in 98 centers across Italy, 1284 of whom were IFN therapy naïve and were included in the post-hoc analysis. In the female group, factors associated with SVR were the presence of HCV genotype 2,3 (adjusted odds ratio [AOR]=6.87, p<0.0001), age ≤45 years (AOR=2.61, p=0.014), ≥80% exposure to PEG-IFN (AOR=3.85, p=0.019) and RBV (AOR=3.94, p=0.015) therapy. Also, increased glucose plasma level negatively correlated with SVR (AOR=0.98, p=0.066). In the male population, undetectable HIV-RNA (AOR=1.47, p=0.033) but not glucose level (AOR=1.0, p=0.95) predicted SVR. CONCLUSIONS Findings from the present study demonstrate that several factors may be predictive of SVR when pegylated interferon plus ribavirin is used (i.e., age, gender, HIV viral load and HCV genotype) that need to be carefully considered prior to therapeutic intervention, since they may hinder successful therapy. Use of PEG-IFN/RBV with novel direct antiviral agents will likely be still maintained until less expensive and effective interferon-free strategies become available.
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Affiliation(s)
- Paola Nasta
- 1 University Division of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital , Brescia, Italy
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Husain NEO, Ahmed MH. Managing dyslipidemia in HIV/AIDS patients: challenges and solutions. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2014; 7:1-10. [PMID: 25565897 PMCID: PMC4274137 DOI: 10.2147/hiv.s46028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human immunodeficiency virus (HIV) is a chronic disease associated with dyslipidemia and insulin resistance. In addition, the administration of combination antiretroviral therapy is associated with an increase in the incidence of metabolic risk factors (insulin resistance, lipoatrophy, dyslipidemia, and abnormalities of fat distribution in HIV patients). HIV dyslipidemia is a common problem, and associated with an increase in incidence of cardiovascular disease. Further challenges in the management of HIV dyslipidemia are the presence of diabetes and metabolic syndrome, nonalcoholic fatty liver disease, hypothyroidism, chronic kidney disease, the risk of diabetes associated with statin administration, age and ethnicity, and early menopause in females. Dyslipidemia in patients with HIV is different from the normal population, due to the fact that HIV increases insulin resistance and HIV treatment not only may induce dyslipidemia but also may interact with lipid-lowering medication. The use of all statins (apart from simvastatin and lovastatin) is safe and effective in HIV dyslipidemia, and the addition of ezetimibe, fenofibrate, fish oil, and niacin can be used in statin-unresponsive HIV dyslipidemia. The management of dyslipidemia and cardiovascular disease risks associated with HIV is complex, and a certain number of patients may require management in specialist clinics run by specialist physicians in lipid disorders. Future research is needed to address best strategies in the management of hyperlipidemia with HIV infection.
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Affiliation(s)
- Nazik Elmalaika Os Husain
- Department of Pathology, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine, Milton Keynes Hospital, NHS Foundation Trust, Milton Keynes, UK
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22
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Womack JA, Chang CCH, So-Armah KA, Alcorn C, Baker JV, Brown ST, Budoff M, Butt AA, Gibert C, Goetz MB, Gottdiener J, Gottlieb S, Justice AC, Leaf D, McGinnis K, Rimland D, Rodriguez-Barradas MC, Sico J, Skanderson M, Tindle H, Tracy RP, Warner A, Freiberg MS. HIV infection and cardiovascular disease in women. J Am Heart Assoc 2014; 3:e001035. [PMID: 25324353 PMCID: PMC4323817 DOI: 10.1161/jaha.114.001035] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background HIV infection is associated with increased risk of cardiovascular disease (CVD) in men. Whether HIV is an independent risk factor for CVD in women has not yet been established. Methods and Results We analyzed data from the Veterans Aging Cohort Study on 2187 women (32% HIV infected [HIV+]) who were free of CVD at baseline. Participants were followed from their first clinical encounter on or after April 01, 2003 until a CVD event, death, or the last follow‐up date (December 31, 2009). The primary outcome was CVD (acute myocardial infarction [AMI], unstable angina, ischemic stroke, and heart failure). CVD events were defined using clinical data, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and/or death certificate data. We used Cox proportional hazards models to assess the association between HIV and incident CVD, adjusting for age, race/ethnicity, lipids, smoking, blood pressure, diabetes, renal disease, obesity, hepatitis C, and substance use/abuse. Median follow‐up time was 6.0 years. Mean age at baseline of HIV+ and HIV uninfected (HIV−) women was 44.0 versus 43.2 years (P<0.05). Median time to CVD event was 3.1 versus 3.7 years (P=0.11). There were 86 incident CVD events (53%, HIV+): AMI, 13%; unstable angina, 8%; ischemic stroke, 22%; and heart failure, 57%. Incident CVD/1000 person‐years was significantly higher among HIV+ (13.5; 95% confidence interval [CI]=10.1, 18.1) than HIV− women (5.3; 95% CI=3.9, 7.3; P<0.001). HIV+ women had an increased risk of CVD, compared to HIV− (hazard ratio=2.8; 95% CI=1.7, 4.6; P<0.001). Conclusions HIV is associated with an increased risk of CVD in women.
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Affiliation(s)
| | - Chung-Chou H Chang
- University of Pittsburgh School of Medicine, Pittsburgh, PA (C.C.H.C., A.A.B., H.T.) University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (C.C.H.C., C.A.)
| | - Kaku A So-Armah
- Yale University School of Medicine, New Haven, CT (K.A.S.A., A.C.J., J.S.)
| | - Charles Alcorn
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA (C.C.H.C., C.A.)
| | - Jason V Baker
- University of Minnesota Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (J.V.B.)
| | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, NY (S.T.B.) Icahn School of Medicine at Mt. Sinai, New York, NY (S.T.B.)
| | - Matthew Budoff
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA (M.B.)
| | - Adeel A Butt
- University of Pittsburgh School of Medicine, Pittsburgh, PA (C.C.H.C., A.A.B., H.T.) VA Pittsburgh Healthcare System, Pittsburgh, PA (A.A.B.) Sheikh Khalifa Medical City, Abu Dhabi, UAE (A.A.B.)
| | - Cynthia Gibert
- VA Medical Center and George Washington University School of Medicine, Washington, DC (C.G.)
| | - Matthew Bidwell Goetz
- David Geffen School of Medicine, University of California, Los Angeles, CA (M.B.G., D.L., A.W.) VA Greater Los Angeles Health Care System, Los Angeles, CA (M.B.G., D.L., A.W.)
| | - John Gottdiener
- University of Maryland School of Medicine, Baltimore, MD (J.G., S.G.)
| | - Stephen Gottlieb
- University of Maryland School of Medicine, Baltimore, MD (J.G., S.G.)
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT (K.A.S.A., A.C.J., J.S.) Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, CT (A.C.J., K.M.G., J.S., M.S.)
| | - David Leaf
- David Geffen School of Medicine, University of California, Los Angeles, CA (M.B.G., D.L., A.W.) VA Greater Los Angeles Health Care System, Los Angeles, CA (M.B.G., D.L., A.W.)
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, CT (A.C.J., K.M.G., J.S., M.S.)
| | - David Rimland
- Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA (D.R.)
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.B.)
| | - Jason Sico
- Yale University School of Medicine, New Haven, CT (K.A.S.A., A.C.J., J.S.) Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, CT (A.C.J., K.M.G., J.S., M.S.)
| | - Melissa Skanderson
- Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, CT (A.C.J., K.M.G., J.S., M.S.)
| | - Hilary Tindle
- University of Pittsburgh School of Medicine, Pittsburgh, PA (C.C.H.C., A.A.B., H.T.)
| | - Russell P Tracy
- University of Vermont College of Medicine, Burlington, VT (R.P.T.)
| | - Alberta Warner
- David Geffen School of Medicine, University of California, Los Angeles, CA (M.B.G., D.L., A.W.) VA Greater Los Angeles Health Care System, Los Angeles, CA (M.B.G., D.L., A.W.)
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Rubin LH, Sundermann EE, Cook JA, Martin EM, Golub ET, Weber KM, Cohen MH, Crystal H, Cederbaum JA, Anastos K, Young M, Greenblatt RM, Maki PM. Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus-infected women. Menopause 2014; 21:997-1006. [PMID: 24496085 PMCID: PMC4119867 DOI: 10.1097/gme.0000000000000203] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the separate and interactive associations of menopausal stage, menopausal symptoms, and human immunodeficiency virus (HIV) infection with cognition. We hypothesized that HIV-infected perimenopausal women would show the greatest cognitive difficulties and that menopausal symptoms would be inversely associated with cognition. METHODS This cross-sectional study included 708 HIV-infected and 278 HIV-uninfected premenopausal, perimenopausal, or postmenopausal women (64% African American; median age, 44 y) from the Women's Interagency HIV Study. Participants completed tests of verbal learning and memory, attention/processing speed, and executive function. We administered a menopausal symptom questionnaire that assessed anxiety, vasomotor, and sleep symptoms and obtained measures of depressive symptoms. RESULTS In multivariable regression analyses controlling for relevant covariates, HIV infection, but not menopausal stage, was associated with worse performance on all cognitive measures (P's < 0.05). Depressive symptoms were associated with lower cognitive performance on measures of verbal learning and memory, attention, and executive function (P's < 0.05); anxiety symptoms were associated with lower performance on measures of verbal learning and memory (P's < 0.05). Vasomotor symptoms were associated with worse attention (P < 0.05). HIV and anxiety symptoms interacted to influence verbal learning (P's < 0.05); elevated anxiety was associated with worse verbal learning in HIV-infected women only. CONCLUSIONS Vasomotor, depressive, and anxiety symptoms, but not menopausal stage, are associated with worse cognitive performance in both HIV-infected and HIV-uninfected women, although elevated anxiety symptoms are more associated with verbal learning deficits in HIV-infected women. Because cognitive problems can interfere with everyday functioning, including treatment adherence, it may be important to screen and treat anxiety in HIV-infected women.
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Affiliation(s)
- Leah H. Rubin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Erin E. Sundermann
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Judith A. Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | | | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Kathleen M. Weber
- The Core Center, Cook County Health and Hospital System and Hektoen Institute of Medicine, Chicago, IL
| | - Mardge H. Cohen
- The Core Center, Cook County Health and Hospital System and Hektoen Institute of Medicine, Chicago, IL
- Departments of Medicine Stroger Hospital and Rush University, Chicago, IL
| | - Howard Crystal
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn NY
| | - Julie A. Cederbaum
- University of Southern California, School of Social Work, Los Angeles, CA
| | - Kathyrn Anastos
- Department of Medicine and Epidemiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Mary Young
- Georgetown University School of Medicine, Washington, DC
| | - Ruth M. Greenblatt
- Departments of Clinical Pharmacy, Medicine, Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Pauline M. Maki
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
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HIV and Menopause: A Systematic Review of the Effects of HIV Infection on Age at Menopause and the Effects of Menopause on Response to Antiretroviral Therapy. Obstet Gynecol Int 2013; 2013:340309. [PMID: 24454386 PMCID: PMC3880754 DOI: 10.1155/2013/340309] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022] Open
Abstract
More than half of persons living with HIV infection in the United States (U.S.) will be ≥50 years of age by 2020, including postmenopausal women. We conducted a systematic literature review about the effects of (1) HIV infection on age at menopause and (2) menopause on antiretroviral therapy (ART) response, in order to inform optimal treatment strategies for menopausal women living with HIV infection. We used the Ovid Medline database from 1980 to 2012. We included studies that focused on HIV-infected persons, included postmenopausal women, and reported outcome data for either age at menopause or response to ART across menopause. We identified six original research articles for age at menopause and five for response to ART across menopause. Our review revealed that current data were conflicting and inconclusive; more rigorous studies are needed. Disentangling the effects of menopause requires well-designed studies with adequate numbers of HIV-infected and HIV-uninfected women, especially disproportionately affected women of color. Future studies should follow women from premenopause through menopause, use both surveys and laboratory measurements for menopause diagnoses, and control for confounders related to normal aging processes, in order to inform optimal clinical management for menopausal women living with HIV.
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Crist MB, Melekhin VV, Bian A, Shintani A, Milne GL, Kallianpur AR, Dageforde LA, Haas DW, Hulgan T. Higher serum iron is associated with increased oxidant stress in HIV-infected men. J Acquir Immune Defic Syndr 2013; 64:367-73. [PMID: 24169121 PMCID: PMC3816092 DOI: 10.1097/qai.0b013e3182a60f36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND F₂-isoprostanes (F₂-IsoP) are oxidant stress biomarkers that are higher in HIV-infected women than men. We explored whether the effect of hemoglobin (Hgb), serum iron, or anemia on F₂-IsoP is different between HIV-infected women and men. METHODS Plasma F₂-IsoP were quantified by gas chromatography/mass spectrometry; clinical and laboratory data were collected at enrollment or from the medical record. Multivariable linear regression was used to assess associations between F₂-IsoP and Hgb, anemia as a dichotomous variable, and serum iron with adjustment for age, sex, race, body mass index, CD4 lymphocyte count, self-reported current smoking status, and antiretroviral therapy. RESULTS Compared with men, women had lower Hgb [median: 12.7 (interquartile range: 11.8-13.9) vs. 14.9 (13.7-15.8) g/dL, P < 0.001], lower iron levels [75 (47-97) vs. 90 (69-121) µg/dL, P = 0.004], more anemia (29% vs. 10%, P < 0.001), and higher levels of F₂-IsoP [42 (32-62) vs. 36 (25-46) pg/mL, P < 0.001]. The relationship between iron and F₂-IsoP differed significantly between men and women (interaction P = 0.02). Men had a 21% (95% confidence interval: 8 to 36) increase in F₂-IsoP per interquartile increase in iron (P = 0.001), whereas no relationship was seen among women [-4% (-17 to 13, P = 0.65]. CONCLUSIONS Although women have overall higher F₂-IsoP than men, a relationship between circulating F₂-IsoP and iron levels was observed in men but not in women with HIV infection. The association between female sex and higher F₂-IsoP is not explained by iron or Hgb levels because the association persists when controlling for these factors. The role of iron in oxidant stress and sex-specific differences among HIV-infected individuals require further study.
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Affiliation(s)
- Matthew B. Crist
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vlada V. Melekhin
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ayumi Shintani
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ginger L. Milne
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Asha R. Kallianpur
- Departments Genomic Medicine and Medicine, Cleveland Clinic Foundation/Lerner Research Institute, Cleveland, Ohio
| | - Leigh Anne Dageforde
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David W. Haas
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
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Lui-Filho JF, Valadares ALR, Gomes DDC, Amaral E, Pinto-Neto AM, Costa-Paiva L. Menopausal symptoms and associated factors in HIV-positive women. Maturitas 2013; 76:172-8. [DOI: 10.1016/j.maturitas.2013.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/04/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Caputo BV, Traversa-Caputo GC, Costa C, Giovani EM. Evaluation of bone alterations in the jaws of HIV-infected menopausal women. Braz Oral Res 2013; 27:231-7. [PMID: 23657485 DOI: 10.1590/s1806-83242013005000014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/05/2013] [Indexed: 11/22/2022] Open
Abstract
The advent of highly active antiretroviral therapy (HAART) has caused a reduction in mortality, thus contributing to an increase in the number of women with HIVࢧAIDS who reach the climacteric period, experience decline in ovarian function, and develop complications of viral infection and HAART, which can accelerate bone loss. The aim of this study was to detect possible alterations in the jaws of HIV-infected women by panoramic radiography. The study comprised a total of 120 women above 40 years of age who were divided into the following two groups: women who are HIV positive (Group I) and women with no known HIV infection (Group II). Measurement of the following three radiomorphometric indexes was performed by panoramic radiography: Mental Index (MI), Panoramic Mandibular Index (PMI) and Antegonial Depth (AD). A total of 70% of women in the control group and 50% of women in the HIV group were in the postmenopausal period, and the average values of both MI (p = 0.0054) and AD (p < 0.0001) for this period were lower in the HIV group than in the control group. For patients who were in the premenopausal period, the average AD was lower in the HIV group than in the control group (p = 0.0003). Despite the difference in the average age between groups, greater bone resorption in the mandible was found in the group of HIV-positive women.
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Affiliation(s)
- Bruno Vieira Caputo
- Center for Study and Care of Special Patients, Dental School, Univ Paulista, São Paulo, SP, Brazil.
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28
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McPheeters C, Gregg J. Treatment Options for Hot Flashes in the HIV-Positive Menopausal Patient. J Nurse Pract 2013. [DOI: 10.1016/j.nurpra.2012.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Menopause-associated metabolic manifestations and symptomatology in HIV infection: a brief review with research implications. J Assoc Nurses AIDS Care 2011; 23:195-203. [PMID: 21924646 DOI: 10.1016/j.jana.2011.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/29/2011] [Indexed: 02/02/2023]
Abstract
Many women living with HIV in the United States have entered or will soon enter menopause. Clinical changes including increased visceral fat, reduced muscle mass, and changes in lipids and bone density are seen across the menopause transition among non-infected women. HIV and antiretroviral therapy use have been associated with similar manifestations, including reduced bone density, and changes in lipid metabolism and body composition. Menopause is also associated with changes in mood, quality of life, and vasomotor symptoms. Similar psychological indices are common among women with HIV, and may worsen during menopause transition. Research investigating the presence and acuity of metabolic, psychological, and vasomotor symptoms among perimenopausal women with HIV is limited. An important, yet unknown consideration for researchers and clinicians is how metabolic and psychological co-morbidities associated with HIV will influence changes associated with menopause in this population. Further research is needed to provide answers to these important questions.
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de Pommerol M, Hessamfar M, Lawson-Ayayi S, Neau D, Geffard S, Farbos S, Uwamaliya B, Vandenhende MA, Pellegrin JL, Blancpain S, Dabis F, Morlat P. Menopause and HIV infection: age at onset and associated factors, ANRS CO3 Aquitaine cohort. Int J STD AIDS 2011; 22:67-72. [DOI: 10.1258/ijsa.2010.010187] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M de Pommerol
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
| | - M Hessamfar
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Services de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de Bordeaux
| | - S Lawson-Ayayi
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
| | - D Neau
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Services de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de Bordeaux
- Université Victor Segalen Bordeaux 2, Bordeaux
| | - S Geffard
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
| | - S Farbos
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier de la Côte Basque
| | - B Uwamaliya
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
| | - M-A Vandenhende
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Services de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de Bordeaux
- Université Victor Segalen Bordeaux 2, Bordeaux
| | - J-L Pellegrin
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Services de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de Bordeaux
- Université Victor Segalen Bordeaux 2, Bordeaux
| | - S Blancpain
- Service de Gynécologie Médicale et Chirurgicale, CHU de Bordeaux, Bordeaux, France
| | - F Dabis
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Université Victor Segalen Bordeaux 2, Bordeaux
| | - P Morlat
- INSERM U897 and Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université Victor Segalen Bordeaux 2
- Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH)
- Services de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de Bordeaux
- Université Victor Segalen Bordeaux 2, Bordeaux
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Patterson KB, Cohn SE, Uyanik J, Hughes M, Smurzynski M, Eron JJ. Treatment responses in antiretroviral treatment-naive premenopausal and postmenopausal HIV-1-infected women: an analysis from AIDS Clinical Trials Group Studies. Clin Infect Dis 2009; 49:473-6. [PMID: 19555288 DOI: 10.1086/600398] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Menopause may affect antiretroviral treatment (ART) response. Immunologic and virologic responses to ART were compared in 220 premenopausal and 47 postmenopausal women enrolled in 2 studies involving ART-naive persons. Changes in CD4 counts or human immunodeficiency virus type 1 RNA levels were similar at 24, 48, and 96 weeks after treatment initiation. ART-naive women should respond to ART regardless of menopausal status.
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Abstract
Although the incidence of HIV in the United States is higher among men compared to women, the global proportion of women versus men who are infected has been approximately 50% since the late 1990s. Women have been under-represented in neuropsychological studies of HIV. A small number of studies have reported a significantly higher prevalence of neurocognitive impairment among HIV+ women compared to HIV- controls regardless of symptom status and with or without an AIDS diagnosis. Impairment was most evident on psychomotor tasks. The risk of neuropsychological impairment was increased among HIV+ women not on antiretroviral therapy. Age and depressive symptoms also increase neurocognitive risk. New neurocognitive studies of ovarian steroid hormones, PTSD and other psychiatric conditions are critical for addressing potential female-specific aspects of HIV-Associated Neurocognitive Disorder. Such studies will also address questions regarding involvement of the hippocampus and verbal memory, which may be of particular significance among HIV+ women.
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