The impact of the menopause transition on the health and wellbeing of women living with HIV: A narrative review.
Improvements in survival due to advances in antiretroviral therapy (ART) have led to a shift in the age distribution of those receiving HIV care, with increasing numbers of women living with HIV (WLHIV) reaching menopausal age. We present a narrative literature review of 26 studies exploring the menopause transition in WLHIV, focusing on: (1) natural history (2) symptomatology and management, and (3) immunologic and virologic effects. Data are conflicting on the association between HIV and earlier age at menopause, and the role of HIV-specific factors such as HIV viral load and CD4 count. There are some data to suggest that WLHIV experience more vasomotor and psychological symptoms during the menopause than HIV-negative women, and that uptake of hormone replacement therapy by WLHIV is comparatively low. There is no evidence that menopause affects either CD4 count or response to ART, although there may be increased immune activation in older WLHIV. We conclude that menopause in WLHIV is a neglected area of study. Specific information gaps include qualitative studies on experiences of reproductive ageing; data on the impact of the menopause on women's quality of life and ability to adhere to health-sustaining behaviors; as well as studies investigating the safety and efficacy of pharmacological and psychosocial interventions. There is likely to be a burden of unmet health need among this growing population, and better data are required to inform optimal provision of care, supporting WLHIV to maintain their health and wellbeing into their post-reproductive years.
Research Department of Infection and Population Health, University College London, Mortimer Market Centre, Off Capper Street, London WC1E 6JB, UK. Electronic address: s.tariq@ucl.ac.uk.
Shema
S
Tariq
Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK. Electronic address: Valerie.Delpech@phe.gov.uk.
Valerie
V
Delpech
Centre for the Study of Sexual Health and HIV, Homerton University Hospital, Homerton Row, London E9 6SR, UK. Electronic address: janderson@nhs.net.
Jane
J
Anderson
D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008593:Menopause / Q000502:physiology / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*
HIV; Menopause; Women