Menopause and HIV: Data Gap, Limited Care

For the first time, people living with HIV have near normal life expectancies. Advancing therapies have resulted in more women living with HIV (WLHIV) who experience menopause. Unfortunately, many WLHIV fall into a knowledge gap: HIV practitioners lack experience in menopause management, while general practitioners’ have little HIV experience. Coupled with the lack of data on menopause and HIV, many WLHIV have limited access to medical care, and support.

Post Reproductive Health has published a review of menopause and HIV data. Researchers aimed to provide insight into general, and unique menopause management considerations in WLHIV.

WLHIV are at elevated risk for comorbidities as their life expectancy increases. Both menopause and HIV infection increase risk for cardiovascular disease, low bone mineral density, osteoporosis, and mental health diagnoses.

Menopause hormone therapy (MHT) treats menopause's common symptoms, and biological changes. This therapy is likely underutilized in WLHIV, due to concern of drug-drug interactions (DDIs) between MHT and antiretroviral therapy (ART). Limited data on these DDIs exists, although data regarding ART, and hormonal contraceptives may be extrapolated.

Transdermal estrogen MHT preparations are preferable in WLHIV because they are associated with a lower venous thromboembolism risk than oral preparations. ART pharmacokinetics do not differ between pre- and postmenopausal WLHIV, confirmed by limited data.

HIV may be related to early onset of menopause. Studies assessing the relationship between age of menopause and HIV-related factors (i.e. viral load, CD4 count, ART use) are conflicting. Evidence that vaginal symptoms of menopause, including vaginal atrophy and estrogen deficiency, increase risk of HIV transmission or acquisition is inconclusive. No current evidence that estrogen deficiency (i.e. the menopausal state) affects CD4 count or response to ART exists.

Menopausal WLHIV deserve the same access to care, and information as other menopausal females. Adequate knowledge about symptomatology, lifestyle modifications, and treatment options is essential for patient care. Multidisciplinary communication between HIV providers and general practitioners is essential for the well-being of WLHIV transitioning through menopause.

Kelsey Fontneau is a 2018 PharmD Candidate at the University of Connecticut School of Pharmacy.

Reference

Bull L, Tittle V, Rashid T, Nwokolo N. HIV and the menopause: a review. Post Reprod Health. doi: 10.1177/2053369117748794.