Severe menopausal symptoms double odds of poor ART adherence in UK women
22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018


Mark Mascolini

Severe menopausal symptoms affected nearly one third of 625 older UK women with HIV and more than doubled the odds of suboptimal adherence to antiretroviral therapy (ART). Unemployment, financial insecurity, and current smoking proved more frequent in women with poor adherence.

UK health workers saw about 10,350 HIV-positive women of potentially menopausal age in 2016, a 5-fold jump over the past 10 years. Because data are scant on how the menopause affects women with HIV, University College London researchers conducted this study. They aimed mainly to explore potential associations between severe menopausal symptoms and adherence to ART in England.

The analysis involved 625 antiretroviral-treated women enrolled in the 2016-2017 observational PRIME Study of 45- to 60-year-old women in England. Researchers used the Menopause Rating Scale to measure symptom severity, with a score of 17 or greater indicating severe symptoms. This validated scale captures somatic, psychological, and urogenital symptoms of menopause. Women completed the CPCRA Antiretroviral Medication Adherence Self-Report Form, which allowed researchers to split women into 2 groups: optimal adherence (100% adherence in the past 7 days) or suboptimal adherence (less than 100% adherence in the past 7 days). To identify predictors of suboptimal adherence, the investigators used logistic regression adjusted for ethnicity, employment, alcohol use, current smoking, and basic needs met.

The adherence analysis indicated that 60 women (9.6%) had suboptimal adherence and 565 had optimal adherence. There were 283 women perimenopausal women (45%) and 201 postmenopausal women (32%), and menopausal status did not differ by adherence category. Only 38 women (6%) had a CD4 count below 200, and only 65 (10%) had a detectable viral load; CD4 count and viral load status did not differ significantly by adherence category.

Most women (65% with suboptimal adherence, 73% with optimal adherence,
P = 0.16) were black African. Higher proportions of women with suboptimal adherence were unemployed (45% versus 29%, P = 0.001), sometimes or never had enough money for basic needs (44% versus 34%, P = 0.005), currently smoked (20% versus 7%, P < 0.001), and had risky alcohol use (25.5% versus 8%, P < 0.001).

Almost one third of women (180, 29%) reported severe menopausal symptoms. Women with severe menopausal symptoms had more than twice higher odds of suboptimal adherence (adjusted odds ratio 2.47, 95% confidence interval 1.27 to 4.82,
P = 0.008). But adjusted analysis found no association between adherence and any of the 3 menopausal symptom domains (somatic, psychological, urogenital).

The researchers called for longitudinal data to confirm that severe menopausal symptoms affect antiretroviral adherence. They suggested that holistic care can address "the multidimensional nature of menopausal symptoms [and] may support midlife women living with HIV in maintaining optimal ART adherence."

Reference
1. Solomon D, Burns F, Gilson R, et al. The association between menopausal symptoms and antiretroviral adherence in women living with HIV. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract WEPEB128. https://programme.aids2018.org//PAGMaterial/eposters/2118.pdf