Women and HIV infection: The makings of a midlife crisis

Abstract

With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at mid-life, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition.

HIV/AIDS in Older Women: Unique Challenges, Unmet Needs

“…HAART has also been associated with elevated LH and FSH which in turn can contribute to menstrual irregularities. 34 Santoro et al 35 review of menopause in women with HIV suggests that women with HIV evidence earlier menopause, though it is unclear whether this is due to HIV per se or to other risk factors for early menopause that tend to cluster in HIV infected women such as smoking, stress, and drug use.…”

“…35,36 Increased cardiovascular disease risk burden is also observed in HIV infected women regardless of whether or not they are receiving HAART. 35 HIV infection has been found to have independent associations with menopause symptoms and in older women, the intersection of HIV and menopause may be observed via greater psychological symptoms from both HIV and menopausal transition. 37 …”

“…Research on the use of post-menopausal hormonal replacement therapies has shown mixed results, and may have some promise for mitigation of symptoms in older women, though further research targeted at HIV infected older women is needed. 64,65 …”

Investigation of menopausal stage and symptoms on cognition in human immunodeficiency virus–infected women

“…Previous cross-sectional studies indicate that compared to HIV-uninfected women, HIV-infected women report more menopausal symptoms including vasomotor, sleep disturbances, and psychological symptoms 2-5 and may have an earlier age at menopause 3, 4, 6, 7 . In the United States, smoking, low socioeconomic status, and drug use are relatively common among women with HIV; these are all factors associated with depression, anxiety, and vasomotor symptoms 8, 9 . No study has yet focused on the effects of menopausal stage and menopausal symptoms on cognition in HIV-infected women.…”

Fertility desires of women living with HIV/aids in northern British Columbia.

“…HIV positive women with risk factors such as, drug use and poverty may experience early menopausal symptom in their 40s and this could be a reason o f expressed decreased desire to have children. Women may also suffer from chronic stress related to HIV which can cause worsened psychological conditions and can affect their fertility desire (Santoro, Fan, Maslow & Schoenbaum, 2009). Older women express decreased fertility desire possibly indicating that they might have already reached their desired fertility goal or they may be accepting o f what they see as a lack of possibility.…”