Infection with HIV and the residual effects of early ART may blunt expected increases in waist circumference and BMI that occur among women during the transition to menopause.
In contrast to women without HIV infection, annual rates of change in BMI and waist circumference were found to decrease during the transition to menopause HIV-positive women. These study results were published in Clinical Infectious Diseases.
Researchers at the University of California, San Francisco sourced data from women with and without HIV infection who were included in the Women’s Interagency HIV Study (WIHS), a multicenter prospective cohort study conducted between 1994 and 2015. This study included patients (N=839) with at least 2.5 years of body composition data after first reaching undetectable anti-Müllerian hormone levels between 2000 and 2014. The researchers aimed to determine the relationship between the transition to menopause and weight gain among women with HIV infection. The primary outcomes were the annual rates of change in BMI and waist circumference.
Among patients with (n=621) and without (n=218) HIV infection included in the analysis, the median age at the initial time of undetectable anti-Müllerian hormone levels was 46 (IQR, 44-47) and 46 (IQR, 44.5-48) years, 57% and 61% were Black, and 24% and 17% had active hepatitis C virus infection, respectively.
Of HIV-positive patients, 71% were receiving antiretroviral therapy, 58% had undetectable HIV viral loads, and the median CD4+ count at initial anti-Müllerian hormone level undetectability was 424 (IQR, 262-642) cells/mm3.
In BMI and waist circumference models, significant interactions between HIV status and the early perimenopause (P <.001) and menopause (P <.001) phases were observed.
For HIV-positive women, the annual rate of change in BMI during the premenopause phase was reduced by 0.55%, 0.29%, and 0.67% in the early perimenopause, late perimenopause, and menopause phases, respectively (P =.005). Similar findings were observed for waist circumference in comparisons between the same 3 phases of menopause, with annual rates of change reduced by 0.21%, 0.18%, and 0.12%, respectively.
For HIV-negative women, the annual rate of change in BMI during the premenopause phase was increased by 0.43% and 0.15% in the early and late perimenopause phases, respectively, but was decreased by 0.40% in the menopause phase. In regard to the annual rate of change in waist circumference, respective increases of 0.35%, 0.48%, and 0.06% were observed across the same 3 phases when compared with the premenopause phase.
Further analysis was performed after adjustments for age, race/ethnicity, enrollment date, and study site. Results showed that the annual rate of change in BMI across the 3 menopause phases remained negative and statistically significant (-0.61, -0.37, and -0.81%, respectively) among HIV-positive patients. Among patients without HIV infection, the annual rate of change in BMI was statistically nonsignificant (0.40%, 0.10%, and -0.46%, respectively).
Among patients with HIV infection, predictors for a decrease in the annual rate of change in BMI during the transition to menopause included heavy alcohol use, detectable HIV viral load (estimate, -0.84%), CD4+ count below 200 cells/mm3, active smoking, and viral hepatitis infection. However, ART use was predictive of an increase in the annual rate of change in BMI. Predictors for a decrease in the annual rate of change in waist circumference included heavy alcohol use, detectable HIV viral load, active smoking, and major depressive disorder.
Study limitations include the use of obesity and visceral adiposity as surrogate markers, and the inability to adjust for integrase inhibitor use.
According to the investigators, “Further study is needed to understand how clinical, behavioral, and immunologic factors influence body composition during the menopausal transition…”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
References:
Abelman RA, Nguyen TTJ, Ma Y, et al. Body composition changes over the menopausal transition in women with and without HIV. Clin Infect Dis. Published online March 28, 2023. doi:10.1093/cid/ciad165
Source : Infectious Disease Advisor
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