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EACS 2011: Do Women with HIV Experience Earlier Menopause?

Premature menopause may be more common among women with HIV, but the difference is primarily driven by women with advanced immune deficiency, according to study results presented at the 13th European AIDS Conference (EACS 2011) this week in Belgrade.

Research over the course of the epidemic has produced conflicting findings about changes in menstruation and menopause among women with HIV, but much of this data came from earlier years when HIV positive people typically developed advanced disease.

Investigators with the DIDI Study looked at prevalence and factors associated with early menopause in HIV positive women. Hormonal changes at menopause increase the risk of co-morbidities including cardiovascular disease and bone loss, they noted as background, which already occur at higher rates among people with HIV.

A total of 352 HIV positive women at 15 infectious diseases clinics in Italy completed anonymous self-administered questionnaires about their overall health status, gynecological health, and mental and physical health. The researchers compared survey findings, demographics, and clinical characteristics of pre-menopausal and early post-menopausal women.

Participants were under 46 years of age (median 40 years), the age at which perimenopause typically occurs among women in the general population. Early menopause was defined as a full year without menstrual periods, not explained by other causes, in women younger than 46 years.

Participating women had been diagnosed with HIV for a median of 11 years; Most were taking antiretroviral therapy (ART) and about 20% had a prior AIDS diagnosis (CDC stage C). In addition, 18% had a history of illegal drug use and 17% were immigrants.

Results

• 27 women (7.6%) reported early menopause.
• In 9 cases (5.2%), early menopause occurred in women less than 40 years of age.
• Women with early menopause were more to have a history of drug use (25.9% vs 17.2%), but this did not reach statistical significance.
• Women with early menopause had been diagnosed with HIV for a significantly longer time (18 vs 10 years) and were more likely to have AIDS (41.7% vs 17.1%).
• However, nadir (lowest-ever) CD4 count and ART use were similar in the pre-menopausal and post-menopausal groups.
• Women with early menopause reported lower overall, physical, and mental health scores.
• In a multivariate analysis controlling for other factors, early menopause was significantly associated with having AIDS (adjusted odds ratio 3.33, or about 3-fold higher risk).
• There was a trend towards an association between younger menopause and younger age at first menstruation, but this did not reach statistical significance.
• Women who reported early menopause were more likely to receive annual mammograms and DEXA scans to monitor bone loss.

The investigators noted that the prevalence of early menopause in this analysis (7.6%) was comparable to the prevalence in a 2003 Italian general population study (7.1%). However, they added, the present study found a higher rate of premature menopause among women under age 40 (5.2% vs 1.8%, respectively).

"Advanced stage of [HIV] disease represents the main predictor of early menopause," they concluded. "As suggested by good clinical practice, post-menopausal HIV [positive] women more likely undergo annual co-morbidity screening."

Investigator affiliations; Clinica di Malattie Infettive,Università di Milano, AO San Paolo, Milano, Italy; INMI L Spallanzani IRCCS, Roma, Italy; Div. Malattie Infettive, Osp. Civile Umberto I, Frosinone, Italy; Clinica di Malattie Infettive, Università Vita-Salute IRCCS San Raffele, Milano, Italy; Divisione di Malattie Infettive, Ospedale 'Santa Maria della Misericordia', Rovigo, Italy; Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy; Clinica di Malattie Infettive, Policlinico Umberto I, Roma, Italy; Divisione Malattie Infettive AO S. Giovanni-Addolorata, Roma, Italy; Clinica Malattie Infettive Università di Perugia, Perugia, Italy; Divisione Malattie Infettive Ospedale Cotugno, Napoli, Italy; Clinica Malattie Infettive Università Bari, Bari, Italy; Unità di Malattie Infettive, AO Ospedale di Circolo di Busto Arsizio, Busto Arsiszio, (VA), Italy; Cilinica di Malattie Infettive, AO Universitaria San Martino, Genova, Italy; Clinica di Malattie Infettive, AOU Careggi, Firenze, Italy.

10/14/11

Reference

P Cicconi, A Ammassari, E Anzalone, et al. Correlates of Early Menopause in HIV-infected Women (DIDI Study). 13th European AIDS Conference (EACS 2011). Belgrade, October 12-15, 2011. Abstract PS2/5.