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Objective: To assess the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection.Methods: We carried out a cross-sectional study of 221 sexually active HIV-infected women ages 40 to 59 years, based on a secondary analysis of a three-hospital survey in Lima, Peru ´. We classified menopausal status according to Stages of Reproductive Aging Workshop criteria (STRAWþ10); this exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and-for exploratory analysis-as multinomial (pre-, peri-, and postmenopausal). We defined low sexual function (LSF) using the 6-item Female Sexual Function Index (total score 19). Socio-demographic and clinical variables were assessed, including age, used highly active antiretroviral therapy scheme, disease duration, depressive symptoms, and co-morbidities. We performed Poisson generalized linear models with a robust variance to estimate 95% confidence interval (CI), crude prevalence ratios (cPRs), and adjusted prevalence ratios (aPRs) by epidemiological and statistical approaches using nonparametric method of bias-corrected and accelerated bootstrap resampling with 1,000 repetitions.Results: Studied women had a median age of 47.0 years (interquartile range: 7.5); 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal. Also, 64.3% had LSF. The frequency of LSF was 53.6% in nonpostmenopausal and 75.0% in postmenopausal women. Postmenopausal status was associated with LSF in both the crude (cPR ¼ 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR ¼ 1.38; 95% CI: 1.12-1.71).Conclusions: HIV-infected postmenopausal women have a higher prevalence of LSF than those nonpostmenopausal ones, even when adjusting for multiple potential confounders.

We have read with interest the article written by Andany et al (1), in which they explain important aspects of the menopausal transition in Women with HIV. The most relevant key points described were the positive effects of highly active anti-retroviral therapy (HAART) on those patients, being one of them, the increasing survival and subsequent higher frequency of women in middle-age period. Therefore, this particular context has allowed to carry out further research about menopausal transition in women with HIV (2). They described that a high proportion of women with HIV have symptoms of premature menopause, than females without HIV; for example a decrease bone mineral density and more quality life impairment (due to climacteric symptomatology). These findings are relevant because this body of evidence could be a basis for proposing a holistic clinical approach and multidisciplinary management of climacteric period in women with HIV. Moreover, negative consequences in several areas of health must be explored in this women's life stage. For example, the premature menopause and its negative repercussion on cardiovascular risk, among others (3,4). Beyond the interesting conclusions reviewed, it is important to take in consideration that the evidence analyzed by the authors is primarily from the United States and Brazil, so it is necessary to study the primary evidence from other Latin-American countries. In that sense, the study of menopause in HIV patients in Peru should be of great importance. Especially when in 2013 around 72000 HIV cases were reported, where 21 000 were women over 30 years old, who would be exposed to hormonal changes including premature menopause (5). Nevertheless, scientific publications about menopause in women with HIV are scarce in Peru, and exploration of climacteric in these patients is uncommon in clinical practice. Consequently, to propose and lead policies that encourage the development of scientific research in this area is essential. Moreover, these policies should focus on the comprehensive assessment of women with HIV, where the hormonal evaluation must be included as part of a multidisciplinary approach.

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