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  Clinical Infectious Diseases, 10 June 2022
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Lauren F. Collins, MD1,2, C. Christina Mehta, PhD, MSPH1, Frank J. Palella, Jr., MD3, Yetunde Fatade, MD4, Susanna Naggie, MD5, Elizabeth T. Golub, PhD6, Kathryn Anastos, MD7, Audrey L. French, MD8, Seble Kassaye, MD9, Tonya N. Taylor, PhD10, Margaret A. Fischl, MD11, Adaora A. Adimora, MD12, Mirjam-Colette Kempf, PhD, MPH13, Phyllis C. Tien, MD14, Anandi N. Sheth, MD1,2, Ighovwerha Ofotokun, MD1,2
Menopause may impact the earlier onset of aging-related comorbidities among women with versus without HIV. We found that menopausal status, age, and HIV were independently associated with higher comorbidity burden; and that HIV impacted burden most in the pre-/peri-menopausal phases.
Women living with HIV (WLWH) are living longer and an increasing number are reaching menopause. From 2014 to 2018, HIV diagnoses increased by 5% among women ≥55 years old1. In this growing population of aging WLWH, unique biologic and psychosocial factors may affect the senescence process, including the menopausal transition and development of non- AIDS comorbidities (NACM).
Menopause is characterized by estrogen depletion, resulting from aging-related declines in ovarian reserve, and is associated with an increased risk of cardiovascular disease (CVD), osteoporosis, and other NACM2. WLWH may experience menopause earlier and with greater symptom intensity than the general female population; however, studies are inconsistent and inconclusive3. HIV-related inflammatory effects on the neuroendocrine axis have the potential to impact menopause timing and severity4,5. Further, the menopausal transition among WLWH may also be affected by antiretroviral exposure and a high prevalence of substance use, viral coinfections, and socioeconomic hardship in this population6.
Leveraging the Women's Interagency HIV Study (WIHS), we previously showed that WLWH versus women without HIV had a higher burden of 10 aging-related NACM overall and specifically among those aged 40-49 and ≥60 years, and had a significantly earlier incidence of NACM7,8. Mechanisms by which menopause may affect the natural history of aging-related NACM among WLWH remain largely unknown; thus, we evaluated whether HIV modifies the effects of age and menopausal status on comorbidity burden.


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