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  17th European AIDS Conference
November 6-9
2019, Basel
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Menopause Does Not Affect HIV or CD4
Response in Multicenter Spanish Group

  17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Virologic and immunologic response to first-line antiretroviral therapy (ART) did not differ greatly between similarly aged premenopausal and menopausal women in a large Spanish multicenter study [1]. Menopausal women recovered a normal CD4/CD8 ratio faster than premenopausal women, but that difference waned between treatment weeks 48 and 96.
Researchers working with the Spanish CoRIS cohort noted that longer life expectancy with HIV means more HIV-positive women now reach the menopause. From 2002 to 2017, average age climbed from 36.7 to 46.7 years in Spanish women with HIV. Because menopause involves ovarian, hormonal, metabolic, and social changes, it can having a wide-ranging impact on women's health, perhaps including their response to ART.
In this study the CoRIS team aimed to compare virologic and immunologic responses to initial ART through 48 and 96 weeks in premenopausal and menopausal women from 45 to 60 years old. CoRIS is an ongoing open multicenter study of HIV-positive people initially naive to ART that began in 2004. This analysis included women who started ART before May 31, 2015.
The researchers defined menopause as 12 consecutive months without menstruation. They defined viral suppression as reaching a viral load below 50 copies, and they measured immunologic response as change in CD4 count and CD4 percentage. A CD4/CD8 ratio at or above 1 was considered normal. Multiple T-cell marker recovery meant reaching a CD4 count above 500 plus a CD4 percent at or above 29%. The investigators used logistic regression to estimate odds ratios for viral suppression, CD4/CD8 ratio, and multiple T-cell marker recovery.
The analysis included 173 premenopausal women and 81 menopausal women (68% and 32%). Median age at the study interview stood at 49 years in premenopausal women and 55 years in menopausal women (P < 0.001). Respective median ages at HIV diagnosis were 40 and 46 (P < 0.001). About 85% in both groups acquired HIV during sex with men. Three quarters of the premenopausal group were Spanish, compared with two thirds of the menopausal group (not significant). Premenopausal women and menopausal women did not differ significantly in proportion of current smokers (47% and 37%), frequent alcohol drinkers (19% and 16%), or former drug users (33% and 24%).
Median age when ART began was significantly younger in the premenopausal group (42.3 versus 48.7, P< 0.001), and a lower proportion of premenopausal women started ART in 2010-2015 (50% versus 68%, P = 0.008).
Proportions of women with viral load suppression were similar in the premenopausal group and the menopausal group at 48 weeks (87.3% and 87.5%) and 96 weeks (86.8% and 93.4%). Adjusted odds ratios (aOR) indicated no significant differences between groups in viral suppression at 48 or 96 weeks.
CD4 cell gain averaged 208 in the premenopausal group and 232 in the menopausal group at 48 weeks, and 292 and 348 at 96 weeks, but these differences did not approach statistical significance. CD4 percentage gain at 48 weeks was significantly greater in premenopausal women than in menopausal women (9.0% versus 7.6%, adjusted mean difference -2.23, P = 0.045). But that difference disappeared at 96 weeks (11.3% and 11.6%). At 48 weeks a higher proportion of menopausal than premenopausal women reached a normal CD4/CD8 ratio (23.6% versus 13.8%, aOR 3.69, P < 0.001), but again the difference disappeared at 96 weeks (23.2% premenopausal and 19.6% menopausal, P = 0.622).
A higher proportion of menopausal women than premenopausal women attained multiple T-cell marker recovery at weeks 48 (11.1% versus 6.9%, aOR 4.27, P = 0.013). But at week 96 the groups did not differ significantly in this outcome (15.4% menopausal and 12.0% premenopausal, P = 0.594).
The CoRIS team concluded that "menopause did not have a negative impact on viral suppression or CD4 change after ART initiation."
1. Alejos B, Suarez I, Sanz N, et al. Does menopause affect treatment response in HIV-infected women? a multicenter cohort in Spain. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PS1/4.