Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
15 04 2022
15 04 2022
Historique:
received:
27
09
2021
accepted:
29
11
2021
pubmed:
27
12
2021
medline:
3
5
2022
entrez:
26
12
2021
Statut:
ppublish
Résumé
Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group. This study was conducted across 3 Canadian provinces from 2015 to 2017. Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications. Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001]. Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.
Sections du résumé
BACKGROUND
Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group.
SETTING
This study was conducted across 3 Canadian provinces from 2015 to 2017.
METHODS
Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications.
RESULTS
Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001].
CONCLUSION
Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.
Identifiants
pubmed: 34954716
doi: 10.1097/QAI.0000000000002897
pii: 00126334-202204150-00005
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
505-510Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Lazarus JV, Safreed-Harmon K, Barton SE, et al. Beyond viral suppression of HIV–the new quality of life frontier. BMC Med. 2016;14:94.
Andany N, Kennedy VL, Aden M, et al. Perspectives on menopause and women with HIV. Int J Womens Health. 2016;8:1–22.
Research on the menopause in the 1990s. Report of a WHO scientific group. World Health Organ Tech Rep Ser. 1996;866:1–107.
Duff PK, Money DM, Ogilvie GS, et al. Severe menopausal symptoms associated with reduced adherence to antiretroviral therapy among perimenopausal and menopausal women living with HIV in Metro Vancouver. Menopause. 2018;25:531–537.
Miller SA, Santoro N, Lo Y, et al. Menopause symptoms in HIV-infected and drug-using women. Menopause. 2005;12:348–356.
Looby SE, Shifren J, Corless I, et al. Increased hot flash severity and related interference in perimenopausal human immunodeficiency virus-infected women. Menopause. 2014;21:403–409.
Fantry LE, Zhan M, Taylor GH, et al. Age of menopause and menopausal symptoms in HIV-infected women. AIDS Patient Care STDS. 2005;19:703–711.
Calvet GA, Grinsztejn BG, Quintana MdeS, et al. Predictors of early menopause in HIV-infected women: a prospective cohort study. Am J Obstet Gynecol. 2015;212:765.e1–765.e13.
Andany N, Kaida A, de Pokomandy A, et al. Prevalence and correlates of early-onset menopause among women living with HIV in Canada. Menopause. 2020;27:66–75.
Tao XY, Zuo AZ, Wang JQ, et al. Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis. Climacteric. 2016;19:27–36.
Katon JG, Gray KE, Gerber MR, et al. Vasomotor symptoms and quality of life among veteran and non-veteran postmenopausal women. Gerontologist. 2016;56(suppl 1):S40–S53.
Faubion SS, Kuhle CL, Shuster LT, et al. Long-term health consequences of premature or early menopause and considerations for management. Climacteric. 2015;18:483–491.
The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2018;25:1362–1387.
Gomes DC, Valadares AL, de Moraes MJ, et al. Low bone mass in human immunodeficiency virus-infected climacteric women receiving antiretroviral therapy: prevalence and associated factors. Menopause. 2015;22:224–230.
Howells P, Modarres M, Samuel M, et al. Experience of hormone replacement therapy in postmenopausal women living with HIV. Post Reprod Health. 2019;25:80–85.
Okhai H, Sabin CA, Haag K, et al. Menopausal status, age and management among women living with HIV in the UK. HIV Med. 2021;22:834–842.
Chirwa M, Ma R, Guallar C, et al. Managing menopause in women living with HIV: a survey of primary care practitioners. Post Reprod Health. 2017;23:111–115.
Loutfy M, de Pokomandy A, Kennedy VL, et al. Cohort profile: the Canadian HIV women's sexual and reproductive health cohort study (CHIWOS). PLoS One. 2017;12:e0184708.
Kaida A, Carter A, Nicholson V, et al. Hiring, training, and supporting Peer Research Associates: operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV. Harm Reduct J. 2019;16:47.
Schneider HP, Heinemann LA, Rosemeier HP, et al. The Menopause Rating Scale (MRS): reliability of scores of menopausal complaints. Climacteric. 2000;3:59–64.
Heckman TG, Somlai AM, Peters J, et al. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care. 1998;10:365–375.
Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:3975–4011.
King EM, Prior JC, Pick N, et al. Menopausal hormone therapy for women living with HIV. Lancet HIV. 2021;8:e591–e598.
Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2021. Available at: https://www.R-project.org/ .
Gass ML, Stuenkel CA, Utian WH, et al. Use of compounded hormone therapy in the United States: report of the North American menopause society survey. Menopause. 2015;22:1276–1284.
Costanian C, Edgell H, Ardern CI, et al. Hormone therapy use in the Canadian Longitudinal Study on Aging: a cross-sectional analysis. Menopause. 2018;25:46–53.
Lakshmi S, Beekmann SE, Polgreen PM, et al. HIV primary care by the infectious disease physician in the United States - extending the continuum of care. AIDS Care. 2018;30:569–577.
Kling JM, MacLaughlin KL, Schnatz PF, et al. Menopause management knowledge in postgraduate family medicine, internal medicine, and obstetrics and gynecology residents: a cross-sectional survey. Mayo Clin Proc. 2019;94:242–253.
Tariq S, Delpech V, Anderson J. The impact of the menopause transition on the health and wellbeing of women living with HIV: a narrative review. Maturitas. 2016;88:76–83.
Brown AF, Pérez-Stable EJ, Whitaker EE, et al. Ethnic differences in hormone replacement prescribing patterns. J Gen Intern Med. 1999;14:663–669.
Woods NF, Mitchell ES. Symptoms during the perimenopause: prevalence, severity, trajectory, and significance in women's lives. Am J Med. 2005;118(suppl 12B):14–24.
Bailey ZD, Krieger N, Agénor M, et al. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389:1453–1463.
Randolph SD, Golin C, Welgus H, et al. How perceived structural racism and discrimination and medical mistrust in the health system influences participation in HIV health services for black women living in the United States south: a qualitative, descriptive study. J Assoc Nurses AIDS Care. 2020;31:598–605.
Pellowski JA, Price DM, Allen AM, et al. The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV. Psychol Health. 2017;32:1127–1139.
Schoenbaum EE, Hartel D, Lo Y, et al. HIV infection, drug use, and onset of natural menopause. Clin Infect Dis. 2005;41:1517–1524.
Donaldson MA, Campbell AR, Albert AY, et al. Comorbidity and polypharmacy among women living with HIV in British Columbia. AIDS. 2019;33:2317–2326.
Collins LF, Sheth AN, Mehta CC, et al. The prevalence and burden of non-AIDS comorbidities among women living with or at risk for human immunodeficiency virus infection in the United States. Clin Infect Dis. 2021;72:1301–1311.
Cvetokic A, K E, Skerritt L, et al. A practical clinical guide to counsel on and manage contraception, pre-conception planning and menopause for women living with HIV. JAMMI. 2021;6:278–295.
Loutfy M, Kazemi M, Pick N, et al. Women-centred HIV care model. Available at: https://www.chiwos.ca/women-centred-hiv-care/?doing_wp_cron=1616459188.3317389488220214843750%E8=en . Accessed January 29, 2021.
Primary Care Guidelines for the Management of HIV/AIDS in Adults in British Columbia. BC Centre for Excellence in HIV/AIDS 2021. Available at: http://www.bccfe.ca/sites/default/files/uploads/primary-care-guidelines/Primary-Care-Guidelines_AUG2021.pdf . Accessed: November 23, 2021.