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Symptom Burden and Inflammatory Cytokines in PLWH in the US:
an analysis by sex, menopause stage and menstrual cycle phase
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IAS 2019 Reported by Jules Levin
Rebecca Schnall, PhD, MPH, RN1, HaomiaoJia, PhD1, Nancy Reame, PhD, MSN, RN1
1Columbia University School of Nursing
AGE: Considerations for The HIV Positive Woman during menopause - (09/19/18)
program abstract
Background: Among persons living with HIV (PLWH), higher rates of symptoms have been identified with aging making the origin of symptoms in midlife women with HIV especially unclear. Although there is a growing body of knowledge characterizing the menopause experience in those with HIV, limited attention has been paid to the converse, namely the impact of reproductive aging on the overall health of those with HIV.
Methods: 100 PLWH (25 men and 75 women recruited by menopause stage: pre, peri and post) completed a blood draw for hormones and cytokines and study questions on demographics, height and weight, reproductive health status, HIV symptoms, PROMIS-29 measures, and most recent viral load; study visits were synchronized to the early follicular phase (day 1-6) in women with regular cycles.
Results: In both sexes, the most burdensome HIV symptoms were muscle aches/joint pain, difficulty falling asleep, fatigue, and hand/foot pain (neuropathy). Three of the five symptoms where burden scores differed by menopause stage related to pain (muscle aches/joint pain, stomach pain, headache) with highest scores in the pre-menopause group; the postmenopausal group also demonstrated a similar burden for muscle aches/joint pain while scores for men and peri-menopause women were lowest and similar. Pain intensity scores on the PROMIS-29 also varied significantly by groups in a similar fashion (p =.03). For the total sample, no sex differences were observed in CRP, TNFa, IL-6 or IL-8. In contrast, when the female group was subdivided by menopause stage and compared to males, significant group differences were observed for TNFα and IL-8. After controlling for sex/menopause status and body-mass index, significant differences were noted in CRP, IL-6 and IL-8 for PLWH who reported muscles aches/ joint pain.
Conclusions: Evidence suggests enhanced burden for HIV-related pain symptoms in women in the early follicular phase, possibly owing to menstruation, and support the need for more targeted investigations in younger cycling women with HIV at multiple phases across the menstrual cycle. Further there is evidence to support that in PLWH, systemic inflammation is heightened even when viral load is undetectable making them at greater risk for comorbidities such as cardiovascular disease.
Address for correspondence:
Rebecca Schnall, PhD, MPH, RN
560 West 168th Street NY, NY 10032
Email: rb897@columbia.edu
Phone: (212) 342-6886
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