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Menopause and HIV: age at onset and associated factors, ANRS CO3 Aquitaine Cohort
M. de Pommerol1,2, S. Lawson-Ayayi1,2, M. Bonarek1,3, S. Geffard1,2, B. Uwamaliya1,2, J.-M. Ragnaud2,3,4, J.-L. Pellegrin2,3,4, S. Blancpain5, F. Dabis1,2,4, P. Morlat1,2,3,4, for the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA)
1INSERM U897, Bordeaux, France, 2Centre Hospitalier Universitaire (CHU) de Bordeaux, Coordination Régionale de la lutte contre l'infection due au VIH (COREVIH), Bordeaux, France, 3Service de Médecine Interne et Maladies Infectieuses, CHU de Bordeaux, Bordeaux, France, 4Université Victor Segalen Bordeaux 2, Bordeaux, France, 5Service de Gynécologie Médicale et Chirurgicale, CHU de Bordeaux, Bordeaux, France
Background: Antiretroviral therapy has extended the average life expectancy of HIV-infected adults (HIV+) and a growing proportion of HIV+ women experience menopausal transition. We aimed to estimate the prevalence of menopause among HIV+ women and to determine factors associated with its early onset.
Methods: Information on menopause was collected using a self-administered questionnaire among HIV+ women followed in a hospital-based cohort (April 2007-February 2008). The responses were linked to information routinely collected. We used a Cox model to investigate factors associated with an earlier onset of menopause among women still menstruated at the time of enrolment.
Results: Among the 404 women enrolled, aged 19-79, 17.1 % were postmenopausal at the time of the study. The prevalence of natural menopause was 61.0% (95% Confidence Interval [CI]: 50.1-71.9%) among women aged >50, 20.7% (CI: 11.6-29.7%) in women aged 45-49, 3.5% (CI: 0.1-6.9%) in women aged 40-44 and 0.8% (CI: 0.0-2.3%) in those aged < 40. The study of the determinants of time to menopause included 362 women still menstruated at baseline (median age 31 years); during a median follow-up of 8.8 years, 41 women experienced menopause with an onset at a median age of 46 years (Inter-quartile range=40-50). The probability of reaching menopause was 4.5% (CI: 2.5-8.0%) at the age of 40, 11.3% (7.2-17.5%) at 45 and 38.9% (26.3-54.9%) at 50. African ethnicity (hazard ratio [HR]=8.16; p=0.001) and history of injecting drug use (IDU) (HR=2.46; p=0.042) were both associated with an increased risk of earlier menopause. Women with CD4 cell count < 200 cells/mm3 at baseline tended to reach menopause earlier (HR=2.25; p=0.069).
Conclusions: Menopause seems to occur earlier in HIV+ women than in the general population (median age at onset: 50 years). Early occurrence of menopause seemed associated with factors already reported in HIV-negative women (IDU, ethnicity) and with HIV-related immunodeficiency.
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