Does menopause transition influence viral suppression and adherence in women living with HIV? Journal of Acquired Immune Deficiency Syndrome
Hachfeld and Atkinson et al. evaluated the occurrence of depression, the need for psychiatric care, and intravenous drug use in women with HIV who transition through menopause in the Swiss HIV Cohort Study. In addition, trends in treatment adherence, viral blips, low-level viremia, and viral failure during menopause were assessed.
All women who experienced menopause between January 2010 and December 2018 were included. Menopause onset was determined as amenorrhea, as first reported by the cohort physician. Trends were assessed within 8 years prior and 8 years after menopause onset. The authors used interrupted time series logistic regression models comparing trends before and after menopause onset.
The study included 1’130 women (25% of African origin), with a median age of menopause onset of 50 years (IQR 32-55). In the 8 years prior to menopause onset, there was an increase in the proportion of individuals with depression (odds ratio 1.04 per year, 95% CI 1.00-1.08) and of individuals receiving psychiatric care (OR 1.02 per year, 0.99-1.05). After menopause onset, the proportion of individuals in psychiatric care decreased, whereas trends in the prevalence of depression remained unchanged. Intravenous drug use at menopause onset was rare and declined further thereafter. Similar to the declining trend in women reporting low treatment adherence, the rate of viral blips, low-level viremia, and viral failures declined significantly in both 8-year periods before and after menopause onset.
In summary, the present study highlights that among women with HIV in perimenopause, HIV treatment outcomes continued to improve, whereas the prevalence of depression and psychiatric care utilization increased over time. These findings suggestthat addressing mental health should be a priority in the clinical care of perimenopausal women with HIV.