Menopause may affect atherosclerosis risk differently in people with HIV, reports US study

People living with HIV (PLWH) may be at greater risk of atherosclerosis during the menopausal transition than HIV-negative people, according to a large longitudinal study in the U.S.

About This Study

“Subclinical atherosclerosis across the menopausal transition in women with and without HIV“ was published online on Nov. 8, 2023, in The Journal of Infectious Diseases. The lead author is Brandilyn A. Peters, Ph.D., of the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine in the Bronx, New York.

Key Research Findings

This analysis of data on 979 participants in the Women’s Interagency HIV Study from 2004-2019 investigated the relationship of HIV and subclinical atherosclerosis pre- and post-menopause. Seventy-two percent of participants were living with HIV, and data encompassed 3,247 person-visits. Longitudinal trajectories of carotid artery intima-media thickness (CIMT), stiffness, and plaque were used to determine the progression of atherosclerosis.

At baseline, 810 (83%) of participants were pre-menopausal, with 247 transitioning to post-menopause during the study period. Median age at self-reported final menstrual period differed slightly by HIV status (49 years and 50 years, respectively, for people living with and without HIV).

Different from general-population studies, no association of CIMT, stiffness, or plaque and menopausal transition was found among the control participants. However, the sociodemographic characteristics of HIV-negative participants in this cohort more closely resemble those of PLWH than those of the general population, which could affect cardiovascular risk factors.

Among participants in the study, an increase in CIMT was accelerated through the menopausal transition. Greater CIMT is associated with higher cardiovascular risk in the general population, but this association is unclear among PLWH.

Discussion Highlights and Implications for Practice

Study limitations identified by authors included the self-reported nature of menopausal status, the lack of hormonal measures, and the study’s observational nature.

The researchers noted that the faster increase in CIMT among PLWH compared to participants without HIV could be related to lower estradiol levels in PLWH pre-menopause and the effects of post-menopausal estrogen depletion on HIV replication. Given the higher CVD risk among PLWH in general and the previously observed benefits of hormone therapy on CIMT, such therapy may be beneficial in PLWH going through menopause, study authors suggested.

By Barbara Jungwirth