Depression common in perimenopause, but HIV suppression rates remain steady, Swiss study reports

Few studies have explored the effects of menopause in people living with HIV (PLWH). Researchers in Switzerland found that mental health issues were common among PLWH approaching menopause, but this did not affect HIV adherence or viral suppression rates.

About This Study

“Does menopause transition influence viral suppression and adherence in women living with HIV?” was published online on Jan. 16, 2023, in Journal of Acquired Immune Deficiency Syndromes. The lead authors are Anna Hachfeld, M.D., and Andrew Atkinson, Ph.D., of Bern University Hospital in Switzerland.

Key Research Findings

Data came from 1,130 postmenopausal cisgender women included in the Swiss HIV Cohort Study, 25% of whom were Black. Information was collected for eight years before onset of menopause and 8 years after. Median age at menopause onset was 50 years, with 10% of participants ceasing to have periods before the age of 45 years. Early menopause was more common among study participants than among the country’s general population.

Diagnoses of depression increased slightly in the lead-up to menopause, with 27% of participants having a diagnosis at menopause onset. The rate of women in psychiatric care also increased during perimenopause, with 17% of participants having received such care by menopause onset. Among postmenopausal women, rates of depression stabilized, and psychiatric care rates fell.

Rates of HIV viremia did not differ by depression status, with 13% of participants having a detectable viral load at menopause onset.

Negative treatment outcomes such as viral blips, low-level viremia, viral failure, and low adherence steadily declined during the menopause transition. In fact, treatment adherence and viral suppression increased with age, as has been shown in other studies among both men and women, according to the study authors.

Discussion Highlights and Implications for Practice

The study authors point out that defining viral blips, low-level viremia, and viral failure varies between published studies, making comparisons difficult. In addition, they explain that the effect of menopausal symptoms on HIV treatment adherence or health care access could not be determined because no data on such symptoms were available. They noted that one other study had suggested that WLWH with severe symptoms are less adherent to their antiretroviral treatment and seek health care less often.

The relatively large number of study participants in psychiatric care at menopause onset suggests the need for mental health screenings in older WLWH, the authors advised. However, depression and other mental health issues did not result in lower adherence or less viral suppression among women in Switzerland.

By Barbara Jungwirth