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Rare Menopausal Hormone Therapy in
HIV+ Women Tied to Lack of Clinician Discussion
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International Workshop on HIV and Aging, September 23-24, 2021
By Mark Mascolini for NATAP and Virology Education
Although almost half of HIV-positive women in a large Canadian study had a major indication for menopausal hormone therapy (MHT), only small minorities had ever used or currently used such therapy [1]. Clinician-led discussion of menopause independently tripled chances of MHT use.
As populations of women with HIV continue to age, more will be entering menopause, defined in this study as lack of menses for 1 year or more. Evidence indicates that HIV-positive women often experience menopausal hot flushes, and early menopause (before age 45) may be more frequent in women with HIV. Both hot flushes and early menopause are first-line indications for MHT. Small studies indicate low use of MHT by HIV-positive women, but no study has explored reasons for low use.
Researchers from the University of British Columbia and other Canadian centers aimed to address these issues in a cross-sectional analysis of the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS). The cohort includes almost 500 women at least 35 years old who self-identify as perimenopausal or menopausal. Women complete surveys with questions on ever or currently using MHT as well as standard sociodemographic and clinical questions. The investigators used logistic regression to delve for factors associated with MHT use.
The study included women in the second CHIWOS recruitment wave (June 2015 to January 2017). Participants had to be female at birth, at least 35 years old, and report perimenopausal or menopausal status or have a menstrual history suggesting menopause. The analysis excluded women without data on past or present MHT use.
The study focused on 472 women with HIV. They had a median age of 54 years (interquartile range 50 to 59). While 51% were white, 25% were black, 18% indigenous people, and the rest some other race/ethnicity or mixed race/ethnicity. Most women (88%) had an undetectable viral load, and 82% had a CD4 count above 200.
Almost half of these women (225 of 472, 47.7%) had a first-line indication for MHT, including 146 with moderate to severe hot flushes, 54 with early menopause, and 25 with both. Among women with an indication for MHT data, only 10.8% reported ever using MHT, and only 5.1% currently used MHT. Available data indicate 2 to 3 times higher MHT use in HIV-negative North American women. Fewer than half of the study group (44.5%) reported discussing menopause with their provider.
Univariable analysis identified two factors associated with ever using MHT: being black rather than white lowered chances of MHT use about 60% (odds ratio 0.42, 95% confidence interval [CI] 0.18 to 0.90, P < 0.05), while discussing menopause with a clinician tripled chances of use (odds ratio 3.12, 95% CI 1.73 to 5.84, P < 0.001). Factors that did not influence use in univariate analysis included age, income, recent illicit drug use, and detectable versus undetectable viral load. In multivariate analysis adjusted for age, viral load, and contraindications to MHT, only discussing menopause with a provider independently favored MHT use (adjusted odds ratio 2.95, 95% CI 1.62 to 5.59, P < 0.001).
The researchers concluded that MHT is often indicated but seldom used in women with HIV. The strong link between clinician discussion of menopause and MHT use, they said, underlines the need for greater menopause awareness and better training for HIV providers. The investigators noted that the study is limited by its cross-sectional design and reliance on self-report of menopausal and MHT status.
Reference
1. King E, Kaida A, Mayer U, et al. Undertreated midlife symptoms for women living with HIV linked to lack of menopause discussions with providers. International Workshop on HIV and Aging, September 23-24, 2021. Abstract 4.
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