HIV and menopause: A systematic review of the effects of HIV infection on age at menopause and the effects of menopause on response to antiretroviral therapy Open Access

Abstract

More than half of persons living with HIV infection in the United States will be aged 50 years or older by 2020, and half of those persons will be women, including menopausal women. Despite this trend among older persons living with HIV, huge gaps exist in our understanding of the impact of HIV on menopausal women. Understanding details about the age of menopause in women living with HIV can contribute to the development of preventive and therapeutic interventions that minimize any long-term, synergistic effects of estrogen deficiency and HIV for HIV-infected older women. Understanding the effect of menopause on immunologic and virological responses to antiretroviral therapy (ART) can contribute to ART optimization across menopause, especially when considered with other co-morbid medical conditions that accompany the aging process. We conducted a systematic review of the effects of HIV infection on age at menopause and effects of menopause on response to ART. We used the electronic Ovid Medline database from 1946 to August 2012. We included English-language studies which focused on HIV-infected persons, had full text available, included post-menopausal women, and reported outcome data for either age at menopause, or response to ART across menopause. Six original research articles were selected for the review of age at menopause; five for the review of response to ART across menopause. Our review revealed that the current data on the effects of HIV infection on age at menopause and the effects of menopause on response to ART are inconclusive, and more rigorous studies are needed. Future studies should recruit a large number of both HIV-infected and HIV-uninfected women across menopause, use a combination of questionnaires and measurements of serum FSH levels for menopause diagnoses, and consider confounders related to age of menopause. Additionally, disentangling the effects of menopause requires well-designed studies that sample a sufficient number of matched HIV-infected pre-menopausal women followed longitudinally across the years of menopause.

Table of Contents

Introduction ...................................................................................................................... 1

Methods ............................................................................................................................ 3

Results ............................................................................................................................... 5

1. Final Articles included in review ............................................................................ 5

2. Age at menopause ................................................................................................... 6

3. Response to ART, baseline CD4 cell counts, and baseline HIV viral loads across menopause 11

3-1. Immunological and virological response to ART across menopause .......... 11

3-2. Baseline CD4 cell counts and HIV viral loads across menopause ............. 15

Conclusion/Recommendations for next steps ................................................................. 17

References ....................................................................................................................... 19

Tables and figures ........................................................................................................... 28

Figure 1: Estimated numbers of women living with HIV infection in 46 states of the United States in 2010 ........ 28

Figure 2: Estimated rates of women living with HIV infection who are around the median age of menopause among all women, by race/ethnicity in 46 states of the United States in 2010 ....... 29

Figure 3: Process of article selection for the final review ......................................... 30

Table 1: Studies evaluating age at menopause in HIV-infected women ................. 31

Table 2: A study evaluating response to ART in HIV-infected women .................. 32

Table 3: Studies evaluating response to ART in HIV-infected persons ...................... 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Immunology Health Sciences, Obstetrics and Gynecology
Keyword	HIV women antiretroviral therapy aging menopause
Committee Chair / Thesis Advisor	Del Rio, Carlos, Emory University
Committee Members	Rennatus, Mdodo, Centers for Disease Control and Prevention Sutton, Madeline, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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