HIV Infection Ups Early Menopause Risk and Its Consequences

Daniel M. Keller, PhD

November 18, 2011

November 18, 2011 (Belgrade, Serbia) — HIV infection heightens the risk for early menopause and its attendant health consequences, Paola Cicconi, MD, from the clinic of infectious diseases at San Paolo University Hospital in Milan, Italy, told delegates here at the 13th European AIDS Conference of the European AIDS Clinical Society (EACS).

Reporting for the DIDI study group, she said that this multicenter Italian surveillance study was based on an anonymous questionnaire completed by 585 HIV-positive women 18 years or older in 2010. In addition to sociodemographic data, it gathered information on recreational drug use, smoking, spiritual and religious attitudes, sexual health, physical health, mental health, and more.

The end points of the part of the study that Dr. Cicconi discussed were early menopause, defined as at least 12 consecutive months of amenorrhea from natural causes occurring at 45 years or younger, or the same duration of amenorrhea occurring at 40 years or younger. The women were asked to rate the frequency of their menstrual flow as being usual, increased, or decreased, and the intensity of flow as increased, decreased, or absent.

She explained that HIV infection and immunosuppression have been associated with the earlier onset of menopause, and postmenopausal women can be at risk for comorbidities because of estrogen deficiency.

Of the 585 women surveyed, 233 were excluded from this analysis because they were older than 45 years, were receiving hormone therapy, or had surgical menopause, leaving 352 women 45 years or younger in the analysis.

"Among the 352 patients 45 years or younger, 27 reported menopause, for a prevalence of 7.7%. Among the 173 women 40 years or younger, 9 reported amenorrhea in the previous 12 months, for a 5.2% prevalence," Dr. Cicconi said. "This last proportion is more than 2-fold [greater than] the one observed in the HIV-negative Italian population." The HIV-negative population experienced a 1.8% prevalence of premature and a 7.1% prevalence of early menopause.

She said the 27 women who experienced early menopause were older (median age, 42 years) than the 325 women who did not (P =.02). The early menopause group also reported lower median estimates of global health (P < .001), physical health (P < .007), and psychological health status (P < .05) on a scale of 0 to 100.

"After adjustment for potential confounders, women who experienced a previous AIDS event had a 3-fold [higher] odds of having early menopause." Annual mammography and dual energy x-ray absorptiometry (DXA) screening were also independent factors associated with early menopause, Dr. Cicconi explained.

Independent Factors Associated With Early Menopause

Factor Adjusted Odds Ratio
(95% Confidence Interval)
P Value
AIDS 3.33 (1.14–8.69) .02
Annual mammography screening 3.07 (0.94–9.98) .06
Annual DXA screening 3.44 (1.09–10.8) .03


Dr. Cicconi concluded that the prevalence of menopause at 45 years or younger in the HIV-infected cohort was about equivalent to that in the general Italian population (7.7% vs 7.1%). However, HIV-infected women had a greater prevalence of menopause at 40 years or younger than women in the population at large (5.2% vs 1.8%).

"Advanced stage of disease is the main predictor of menopause at 45 years or younger. This is in line with previous reports," she said.

A limitation of the study is that the age of onset of menopause was not available, so incidence analysis could not be performed; only the prevalence could be assessed, which could have been underestimated. A further limitation is that the study was based on self-reports, with an attendant high risk for recall bias. Furthermore, no hormonal measurements were taken, so menopause could have been the result of confounding factors, not natural factors.

Paul Sax, MD, associate professor of medicine at Harvard Medical School and clinical director of the division of infectious diseases and the HIV program at Brigham and Women's Hospital in Boston, Massachusetts, noted that effective therapy has prolonged the survival of patients with HIV, so studies of the consequences of aging are increasingly important. "However, the results of this particular study did not yield any notable findings that would change clinical practice," he told Medscape Medical News. Dr. Sax is also editor-in-chief of Journal Watch: AIDS Clinical Care.

He advised that the aging process in HIV-infected women should be managed in the same manner as in HIV-negative women.

"As has been shown in other studies of non-AIDS complications, the more advanced the HIV disease, the more 'accelerated' the aging process. I suspect this is true of other severe chronic diseases as well," Dr. Sax said. "Since people with HIV are at increased risk of low bone density, DXA scans are particularly important in postmenopausal women."

Also well documented is the higher cardiovascular risk for people with HIV, compared with age-matched HIV-negative control subjects. "As a result, clinicians should be especially vigilant about strategies to reduce cardiovascular risk, including reminders about lifestyle modification, aggressive treatment of dyslipidemia, and, if virologically safe, alteration of antiretroviral regimens," Dr. Sax recommended.

Finally, he said, additional research on the clinical course of postmenopausal HIV-infected women "would be most welcome."

Dr. Sax reports being an advisor or consultant for Abbott Laboratories, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck & Co., Pfizer, and Tibotec; and receiving grants for clinical research from GlaxoSmithKline, Merck & Co., and Tibotec.

13th European AIDS Conference of the European AIDS Clinical Society (EACS): Abstract PS2/5. Presented October 13, 2011.

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