Abstract
ABSTRACT Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance. We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression. Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms. Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.
Highlights
In 2017, over half of the estimated 34.5 million adults living with HIV globally were female (UNAIDS Data, 2017, 2017); in the United Kingdom, there were an estimated 31,600 women living with HIV in 2015 (Kirwan PD et al, 2016), nearly a third of all those living with HIV nationally
The adherence analysis included women who reported being on antiretroviral therapy (ART) and had available data on their adherence (661/869), while the clinic attendance analysis included women who had available data on their HIV clinic attendance, regardless of whether or not they were on ART (692/869)
We present one of the largest studies in women living with HIV to date, exploring the association between menopausal status and symptoms, and engagement with HIV care
Summary
In 2017, over half of the estimated 34.5 million adults living with HIV globally were female (UNAIDS Data, 2017, 2017); in the United Kingdom, there were an estimated 31,600 women living with HIV in 2015 (Kirwan PD et al, 2016), nearly a third of all those living with HIV nationally. As antiretroviral therapy (ART) has become more effective and more widely available, HIV has transformed from a life-limiting condition into one, for those who are well-controlled on treatment, with near-normal life expectancy (Samji et al, 2013). This has resulted in increasing numbers of people living with HIV surviving into older age, meaning that effective HIV management requires an understanding of the physiological and psychological processes of ageing. The data are conflicting, several studies have indicated that women with HIV may experience menopause at an earlier age than their HIV-negative counterparts (Tariq et al, 2016). Women with HIV experience a high rate of vasomotor, urogenital and psychological menopause-related symptoms – higher, in some studies, than among women who are not living with HIV (Ferreira et al, 2007; Looby et al, 2014; Looby et al, 2018) - while simultaneously reporting low rates of hormone replacement therapy (HRT) use (Clark et al, 2000; Samuel et al, 2014; Tariq S et al, 2017)
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