Abstract
Purpose of ReviewTo describe research advances in the menopausal transition (MT) and its effects on HIV replication, immune activation, and metabolic parameters in women living with HIV (WLWH).Recent Findings.Physiologic changes due to declines in ovarian reserve characterize the MT. Evidence suggests that estrogen depletion influences HIV replication and the latent reservoir. Changes in markers of immune activation, waist circumference, and neurocognition, independent of chronologic age, occur before the final menstrual period (FMP). HIV effects on gut microbial translocation and adipose tissue, as well as health disparities in WLWH may contribute. Improved biomarker sensitivity to predict FMP provides opportunities to study MT in WLWH.SummaryResearch is needed to determine the effects of MT and HIV on virologic and clinical outcomes, using accurate assessments to predict the FMP and menopausal stages. These findings could inform the timing of interventions to prevent early onset of adverse outcomes in WLWH.
Highlights
The extended survival afforded by effective antiretroviral therapy (ART) has enabled women with HIV to live well into their postmenopausal years
These immune and metabolic perturbations, and its clinical sequelae are especially relevant to women living with HIV (WLWH), as HIV infection itself has been associated with gut microbial translocation, immune activation and systemic inflammation, and metabolic perturbations, which have been implicated in the early onset of clinical outcomes such as cardiovascular disease and low bone density [5–10]
Women had a median age of 45 years, so some premenopausal women may have been in the perimenopausal transition when fluctuating and declining estradiol levels are occurring. Another recent study that examined resting T cells isolated from 14 virally suppressed WLWH at multiple time points across the menopausal transition found significantly higher levels of inducible HIV RNA + cells using a sequencing-based assay in postmenopausal women compared to peri- and premenopausal women, and in perimenopausal women compared to premenopausal women [28]. These results suggest that estrogen depletion with aging affects the immune response to HIV including the activity and size of the HIV reservoir
Summary
The extended survival afforded by effective antiretroviral therapy (ART) has enabled women with HIV to live well into their postmenopausal years. The perimenopause period is characterized physiologically by compensatory changes in ovarian and pituitary hormone production due to declines in ovarian reserve (i.e., the number of follicles remaining in the ovary), irregular menstrual cycles, and in some women, overt vasomotor symptoms [3]. During this period, alterations in immune function and inflammatory responses, and metabolic parameters have been reported to occur, with menopause serving as a well-known risk factor for clinical outcomes such as cardiovascular disease, osteoporosis, and neurocognitive changes.
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