Menopause does not affect response to HIV treatment

Menopausal status does not affect responses to HIV treatment, US investigators report in the August 1^st edition of Clinical Infectious Diseases. In the largest ever study into the impact of menopause on the effectiveness of HIV treatment, the researchers found that CD4 cell counts and viral loads were comparable in pre- and post-menopausal women two years after initiating potent HIV therapy.

“Women respond equally well to antiretroviral therapy in the short and long term regardless of menopausal status,” comment the investigators.

Equal numbers of men and women are infected with HIV around the world. In 2006, 15% of all new HIV diagnoses in the US involved patients over the age of 50. Therefore, the number of mature HIV-positive women in the US (and other countries) is expected to increase in the coming years and decades.

There is little information on the impact of the menopause on the natural history of HIV infection or the effectiveness of antiretroviral therapy. There is some concern, however, that the beneficial effects of oestrogen on immune function and control of viral load will be lost due to the menopause.

Investigators therefore analysed the results of two HIV treatment studies (ACTG 5095 and ACTG 5142) to determine the effect of menopause on long-term responses to HIV treatment in terms of CD4 cell count and suppression of viral load to undetectable levels.

Women were defined as pre-menopausal if they were aged under 30, or post-menopausal if aged over 55. The menopausal status of women between these ages was determined after the analysis of information provided by the patients.

CD4 cell count and viral load were monitored at baseline and then 24, 48 and 96 weeks after starting HIV treatment.

A total of 220 pre-menopausal women and 47 post-menopausal women were included in the investigators’ analysis.

Unsurprisingly, the pre-menopausal women were younger, having a median age of 35 years compared to a median age of 54 years in the post-menopausal women (p < 0.001).

Baseline CD4 cell counts were comparable in the two groups (181 cells/mm³ vs 244 cells/mm³). However, pre-menopausal women had significantly lower viral load than women past the menopause (median, 46,000 copies/ml vs 96,000 copies/ml, p = 0.006).

When investigators monitored responses to HIV treatment, they found that these were comparable in pre- and post-menopausal women in both the short and long term.

Increases in CD4 cell count were similar between pre- and post-menopausal women at week 24 (118 cells/mm³ vs 116 cells/mm³), week 48 (185 cells/mm³ vs 195 cells/mm³) and week 96 (260 cells/mm³ vs 273 cells/mm³). Changes in median CD4 cell percentage were also similar.

Moreover, the proportion of pre- and post-menopausal women achieving a viral load below 50 copies at all time points was similar (24 weeks, 74% vs 68%; 48 weeks, 77% vs 81%; and 96 weeks, 75% vs 77%).

“This analysis demonstrates the similarity in virologic and immunologic responses to antiretroviral therapy in treatment-naive pre-menopausal and post-menopausal women initiating antiretroviral therapy,” write the investigators.

The investigators conclude “postmenopausal women benefit from antiretroviral therapy and that similar responses are maintained through two years of follow-up. Therefore, clinicians should anticipate that treatment-naïve HIV-1-infected women should achieve immunologic and virologic responses to antiretroviral therapy regardless of menopause status.”