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HIV+ Women & Aging: worse for women with HIV
  .......women reported worse quality of life, physical function, exhaustion; increased fracture rate for HIV+ women - menopause appears to contribute to worse aging, cognitive function; fracture risk rises farther as women transition through the menopause, "particularly if they are already frail........HIV infection and frailty independently boosted chances of first fractures in a 10-year comparison of US women with or without HIV in the Women's Interagency HIV Study (WIHS) [1]. Women with HIV had clinically defined frailty significantly more often than women without HIV."
Cumulative Affects of Aging & HIV: mental & physical affects Reported at 2018 aging Workshop - 'mental & physical functional Disabilities'
20-40 years of living with HIV & being Over 60-65 Years old & its cumulative affects results in older HIV+ over 60-65 with
.....one not mentioned or discussed much is fatty liver disease in HIV+, which is in reality a comorbidity. Studies report prevalence in PLWH can be double - as high as 40% to 50% that of HIV uninfected and it occurs in HCV/HIV connected and HIV moninfected, those not infected with HCV or HBV, so even after HCV is eradicated by DAA therapy one recently published study found that after HCV eradication by DAAs fatty liver disease remained for many. The concern is that fatty liver disease can progress over many years and although in a relatively small number can rest in advanced fibrosis, liver disease, which can result in HCC. Indeed recent conference reports find liver disease deaths due to HCV among HIV+ declining due to DAAs but liver disease deaths increasing due to fatty liver disease progression.
HIV+ WOMEN& Aging - women appear to age worse than men. Several studies report on this. Menopause in HIV+ occurs prematurely and has a greater negative affect on HIV+ women, they experience more adverse effects of menopause & at earlier ages.
Frailty Predicts Fractures Among HIV-infected and Uninfected Women: Results from the Women's Interagency HIV Study - (09/17/18)
AGE: HIV and frailty predict first fracture in middle-aged US women's cohort - doubled fracture rates - Mark Mascolini (09/19/18)

HIV infection and frailty independently boosted chances of first fractures in a 10-year comparison of US women with or without HIV in the Women's Interagency HIV Study (WIHS) [1]. Women with HIV had clinically defined frailty significantly more often than women without HIV......frailty among HIV+ women in WIHS increased by almost double the risk for fracture. Ever opiate or cocaine use was also associated with increased risk. Feelings of exhaustion increased feature risk, so did reduced grip strength, and unintentional weight loss which might be reflective of declining health & exhaustion. Being Black or latino increased risk compared to whites, so did current smoking. One questioner asked if frailty among HIV+ men increased fracture risk and the response by Dr Sharma was probably, and yes of course I agree its likely many of these risk factors here apply to men as well, and frailty increases fall and fracture risk. Bone mineral density has been found to decline more quickly in HIV+ women vs HIV+ men. Of note you will see in graph below that after age 50 fracture rates increase a lot more quickly among HIV+ men & women than for HIV- showing the greater fracture risk older aging HIV+ face. New fractures in HIV+ women is greater in WIHS compared with HIV-, see graph below. Fractures incidence is also higher in MACS HIV+ men vs HIV- and also appears to increase more quickly after age 50, see graph below. A question for HIV is if recovery after fracture in older HIV+ is much more difficult than for HIV-, this remains unresearched and unanswered. It is one of the questions, more patient focused type of research in aging & HIV we need.
AGE: Considerations for The HIV Positive Woman during menopause - (09/19/18)


"....early onset of menopause in women with HIV"....Being HIV+ increased the likelihood of experiencing menopausal symptoms by between 24-65% across studies. WLWH > 45 years age - • Higher anxiety scores and severe depression compared to WLWH < 45 years
• Menopause Specific Quality in Life Questionnaire -High reports of distressing symptoms -35/57 did not seek help for symptoms
AGE: Physical function worse in older women than men with HIV, despite better CD4 recovery 55% of men & women with poor physical functioning, exhaustion, pain
Older women with HIV had significantly worse physical function and quality of life than older men,
according to analysis of 1126 people in the Modena HIV cohort [1]. Women's worse physical function contrasted with their better CD4 recovery and lower cardiovascular disease rates and risk than men. [from Jules: as mentioned in slide in talk HIV stigma & impact of HIV on everyday life, and HIV-related coping & depression, and toxicities can affect functioning.]
Women reported more exhaustion. Exhaustion (rarely: <1day/week) was reported by 56% of women vs 68% of men. BUT, exhaustion 1-2d/week was reported by 33% of women vs 25% of men. Exhaustion 3-4 d/week was reported by 9% of women vs 5.8% of men. Always or almost always exhaustion (5-7 d/week was reported by 3 women (1.1%) and 2 men (0.2%). see table below.


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