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

Abstract

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

Brief Report: Does Menopause Transition Influence Viral Suppression and Adherence in Women Living With HIV?

“…[20][21][22] Moreover, disregarding menopause, adherence and viral suppression improve in both sexes over time being on ART and increasing age. [23][24][25] Our results not only confirm this but also show that viral suppression is not significantly affected by menopause transition. Our findings are supported by Okhai et al 23 who also reported higher viral suppression rates and fewer viral rebounds in perimenopausal women compared with younger women.…”

“…[23][24][25] Our results not only confirm this but also show that viral suppression is not significantly affected by menopause transition. Our findings are supported by Okhai et al 23 who also reported higher viral suppression rates and fewer viral rebounds in perimenopausal women compared with younger women. The steeper decline of LLV after menopause onset compared with before is difficult to interpret.…”

Patterns of mental health symptoms among women living with HIV ages 45-60 in England: associations with demographic and clinical factors

“…12,[33][34][35] Recent studies have highlighted the association between menopausal age and/or symptoms and reduced clinic attendance and adherence to ART. [36][37][38][39] Our analysis adds to this emergent literature. We did not find evidence that mental health class membership was associated with undetectable last viral load or CD or CD4 count 200 cells/mm 3 .…”