Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

Toorabally, Nasreen; Mercer, Catherine H; Mitchell, Kirstin R; Blell, Mwenza; Burns, Fiona; Gilson, Richard; McGregor-Read, Janine; Allan, Sris; Ruiter, Annemiek de; Dhairyawan, Rageshri; Fox, Julie; Gilleece, Yvonne; Jones, Rachael; Mackie, Nicola; Obeyesekera, Sharmin; Post, Frank; Reeves, Iain; Rosenvinge, Melanie; Ross, Jonathan; Sarner, Liat; Sullivan, Ann; Tariq, Anjum; Ustianowski, Andrew; Sabin, Caroline; Tariq, Shema

doi:10.1080/09540121.2019.1653436

Cited by 12 publications

(21 citation statements)

References 34 publications

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“…For each symptom, perceived severity was scored on a Likert-type scale from 0 ( symptoms not present ) to 4 ( very severe ). A composite score was calculated by summing the scores and was categorized as: no/few (0–4), mild , 5 – 8 moderate 9 – 16 and severe (⩾ 17) symptoms. 19 …”

Section: Methodsmentioning

confidence: 99%

Association between health-related quality of life and menopausal status and symptoms in women living with HIV aged 45–60 years in England: An analysis of the PRIME study

Dragomir¹,

Pool

Sabin

et al. 2022

Womens Health (Lond Engl)

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Objectives: The aim of this study was to compare the health-related quality of life between mid-life women with HIV and the general population and to investigate the association between health-related quality of life and menopausal (1) status and (2) symptoms among women with HIV. Methods: Cross-sectional data of women with HIV aged 45–60 years from the Positive Transitions Through the Menopause Study. Health-related quality of life was assessed using the Euroqol questionnaire with utility scores categorizing health as perfect (score = 1.00), sub-optimal (0.75–0.99) or poor (< 0.75). Scores were compared between Positive Transitions Through the Menopause study participants and women (aged 45–59 years) from the Health Survey for England. Associations between health-related quality of life and menopausal status/symptoms in Positive Transitions Through the Menopause participants were assessed using a multivariable two-part regression model, the results of which are combined to produce a single marginal effect. Results: In total, 813 women from the Positive Transitions Through the Menopause study were included (median age 49 (interquartile range: 47–53) years); the majority were of Black African ethnicity (72.2%). Overall, 20.9%, 43.7% and 35.3% of women were pre-, peri- and post-menopausal, respectively, and 69.7% experienced mild/moderate/severe menopausal symptoms. Approximately, 40% reported perfect health, 22.1% sub-optimal health and 39.0% poor health, similar to women from the Health Survey for England (perfect health: 36.9%, sub-optimal health: 25.2%, poor health: 37.9%). In multivariable models, we found an association between health-related quality of life and peri-menopausal status (marginal effect: 0.07 (0.02, 0.12)); however, the association with post-menopausal status was attenuated (marginal effect: 0.01 (–0.05, 0.06)). There remained a strong association between lower utility scores and moderate (marginal effect: 0.16 (0.11, 0.20)) and severe (marginal effect: 0.32 (0.27, 0.39)) menopausal symptoms. Conclusion: There were no differences in health-related quality of life between women with HIV (Positive Transitions Through the Menopause participants) and women from the Health Survey for England dataset. Among Positive Transitions Through the Menopause participants, health-related quality of life was reduced in peri-menopausal women and those with increasingly severe menopausal symptoms. Our findings highlight the importance of proactive assessment of menopausal status and symptoms to optimize health-related quality of life in women living with HIV as they reach mid-life and beyond.

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Section: Methodsmentioning

confidence: 99%

Association between health-related quality of life and menopausal status and symptoms in women living with HIV aged 45–60 years in England: An analysis of the PRIME study

Dragomir¹,

Pool

Sabin

et al. 2022

Womens Health (Lond Engl)

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“…Several studies have shown the negative impact of menopause on sexual functioning among healthy women, with impairment of their quality of life 15,16 . As expected, low sexual function (LSF) is more common in postmenopausal compared to premenopausal women living with HIV 7 . This situation is even worse since an increased probability of premature menopause 17 and more severe menopausal symptoms has been observed in HIV-infected women 18,19 .…”

mentioning

confidence: 91%

“…Therefore, as part of the comprehensive evaluation of HIV, the sexuality arena requires special attention. Even though the prevalence of sexual problems is higher in HIV-infected women than in noninfected ones, 6,7 the literature is still limited. Unfortunately, a meta-synthesis revealed that living with HIV was a burden for women in sexuality and reproduction 8 .…”

mentioning

confidence: 99%

“…15,16 As expected, low sexual function (LSF) is more common in postmenopausal compared to premenopausal women living with HIV. 7 This situation is even worse since an increased probability of premature menopause 17 and more severe menopausal symptoms has been observed in HIV-infected women. 18,19 Nevertheless, a systematic review highlighted evidence gaps in the knowledge of the HIV infection in terms of age at menopause.…”

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confidence: 99%

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Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection

et al. 2022

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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.

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“…Both HIV and menopause are associated with an increased risk of comorbidities, particularly osteoporosis, insulin resistance [2][3][4] and cardiovascular disease [5][6][7] and are associated with increased rates of mental ill health compared with HIVnegative, non-menopausal women [8][9][10]. In addition, recently published data report lower overall sexual function in HIV-positive women accessing care in England compared with HIV-negative women [11]. The apparent effects of menopause on physical and mental health led to the publication of the British Menopause Society (BMS) vision statement for menopause care in the UK, which recommends delivery of integrated care based on the needs of the individual [12].…”

Section: Introductionmentioning

confidence: 99%

Reflections on a specialist HIV menopause service

et al. 2022

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Objectives We describe here characteristics and clinical outcomes of women living with HIV attending an HIV menopause service. Methods This was a retrospective case note review of women attending the monthly HIV menopause clinic from January 2015 to July 2018. Results In all, 55 women attended the service. The overall mean age was 49 years; 50% were black and 20% had a previous AIDS‐defining condition. All were on antiretroviral therapy (ART); the median CD4 count was 678 cells/µL; 93% had a viral load < 50 copies/mL; 7% had previous hepatitis C infection; 27% had a history of smoking; 45% had risk factors or existing cardiovascular disease; 24% had a mental health condition. The median duration of symptoms before clinic attendance was 18 months. Vasomotor symptoms (84%), menstrual cycle changes (62%), psychological (56%) and urogenital symptoms (29%) were reported. Twenty‐two per cent had early menopause or premature ovarian insufficiency. The mean age at attendance of women diagnosed with menopause (n = 24) was 52 years. However, their average duration of symptoms prior to review was 28 months. A total of 61% had osteopenia/osteoporosis, 73% received menopausal hormone therapy (MHT), and 73% had symptomatic improvement, although 58% of these required higher doses of MHT. Median time on MHT was 10 months. Five patients had their ART modified. No serious MHT adverse effects were observed. Conclusions Menopausal hormone therapy uptake was high, with most women observing an improvement in symptoms. Comorbidities were common, highlighting the need for integrated care based on a woman's needs. The long delay from initial symptoms to treatment demonstrates the need for better access to specialist advice for women experiencing menopause.

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Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

Cited by 12 publications

References 34 publications

Association between health-related quality of life and menopausal status and symptoms in women living with HIV aged 45–60 years in England: An analysis of the PRIME study

Association between health-related quality of life and menopausal status and symptoms in women living with HIV aged 45–60 years in England: An analysis of the PRIME study

Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection

Reflections on a specialist HIV menopause service

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