By Liz Highleyman

Early Menopause

Thanks to effective treatment, more and more HIV positive women are reaching the age of menopause, which typically begins between the ages of 45 and 55 years.

Researchers with the French Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA) performed a study to estimate the prevalence of menopause among HIV positive women and to determine factors associated with early menopause onset.

The analysis included HIV positive women aged 19-79 years seen at Centre Hospitalier Universitaire in Bordeaux between April 2007 and February 2008. Participants completed self-administered questionnaires about menstruation and menopause symptoms.

The investigators used a Cox statistical model to analyze factors associated with early onset of menopause among women who were still menstruating at the time of study enrollment.

	Among the 404 women enrolled, 17.1 % were post-menopausal at the time of the study.
	The prevalence of natural menopause (i.e., not due to ovary removal, hormone therapy, or other interventions) was as follows:
	61.0% among women older than 50 years; 20.7% among women aged 45-49 years; 3.5% among women aged 40-44 years; 0.8% among women younger than 40 years.
	Looking at 362 women who were still menstruating at study entry (median age 31 years), 41 entered menopause during a median follow-up period of about 9 years.
	Within this group, the median age of menopause onset was 46 years.
	The probability of reaching menopause was 4.5% at age 40, 11.3% at age 45, and 38.9% at age 50.
	African ethnicity (hazard ratio [HR] 8.16; P = 0.001) and history of injection drug use (HR 2.46; P = 0.042) were both significant predictors of earlier menopause.
	Women with a CD4 count < 200 cells/mm3 at baseline tended to enter menopause earlier than those with better preserved immune function, though the difference did not reach statistical significant (HR 2.25; P = 0.069).

"Menopause seems to occur earlier in HIV positive women than in the general population (median age at onset: 50 years)," the researchers concluded. "Early occurrence of menopause seemed associated with factors already reported in HIV-negative women (injection drug use, ethnicity) and with HIV-related immunodeficiency."

INSERM U897, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH), Bordeaux, France; Service de Médecine Interne et Maladies Infectieuses, CHU de Bordeaux, Bordeaux, France; Université Victor Segalen Bordeaux 2, Bordeaux, France; Service de Gynécologie Médicale et Chirurgicale, CHU de Bordeaux, Bordeaux, France.

Menopause and Treatment Response

In the second study, published in the August 1, 2009 issue of Clinical Infectious Diseases, U.S. researchers compared virological and immunological response to ART in pre-menopausal and post-menopausal women.

This issue is of interest because hormone levels, which typically change dramatically with menopause, may influence immune function, metabolism, and other processes related to HIV disease progression and treatment.

The analysis included 220 pre-menopausal and 47 post-menopausal women enrolled in 2 studies of treatment-naive patients (ACTG 5095 and ACTG 5142). Women were classified on the basis of age: pre-menopausal if younger than 30 years or post-menopausal if older than 55 years. Baseline CD4 cell counts were comparable in the 2 groups, at around 200 cells/mm3, but the pre-menopausal women had significantly lower baseline viral load.

Results

	Changes in HIV viral load were similar in the pre- and post-menopausal groups at 24, 48, and 96 weeks after treatment initiation.
	Similar proportions of pre- and post-menopausal women achieved viral load < 50 copies/mL:
	24 weeks: 74% vs 68%, respectively; 48 weeks: 77% vs 81%; 96 weeks: 75% vs 77%.
	CD4 counts were also similar in the pre- and post-menopausal groups at all time points studied:
	24 weeks: 118 vs 116 cells/mm3, respectively; 48 weeks: 185 vs 195 cells/mm3; 96 weeks: 260 vs 273 cells/mm3.
	Changes in CD4 cell percentages were also similar in the 2 groups.

Based on these findings, the study authors concluded that treatment-naive HIV positive women "should achieve immunologic and virologic responses to antiretroviral therapy regardless of menopause status."

University of North Carolina, Chapel Hill, NC; University of Rochester, Rochester, NY; Harvard School of Public Health, Boston, MA.

10/13/09

References

M de Pommerol, S Lawson-Ayayi, M Bonarek, and others. Menopause and HIV: age at onset and associated factors, ANRS CO3 Aquitaine Cohort. 5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009). July 19-22, 2009. Cape Town, South Africa. (Abstract).

K Patterson, SE Cohn, J Uyanik, and others. Treatment responses in antiretroviral treatment-naive premenopausal and postmenopausal HIV-1-infected women: an analysis from AIDS Clinical Trials Group Studies. Clinical Infectious Diseases 49(3): 473-476. August 1, 2009. (Abstract).