简短报告：感染艾滋病毒的中年女性未得到治疗的症状与缺乏与医疗服务提供者关于更年期的讨论有关。

Brief Report: Undertreated Midlife Symptoms for Women Living With HIV Linked to Lack of Menopause Discussions With Care Providers.

作者信息

King Elizabeth M, Kaida Angela, Mayer Ulrike, Albert Arianne, Gormley Rebecca, de Pokomandy Alexandra, Nicholson Valerie, Cardinal Claudette, Islam Shaz, Loutfy Mona, Murray Melanie C M

机构信息

Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada.

Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver, British Columbia, Canada.

出版信息

J Acquir Immune Defic Syndr. 2022 Apr 15;89(5):505-510. doi: 10.1097/QAI.0000000000002897.

DOI:10.1097/QAI.0000000000002897

PMID:34954716

Abstract

BACKGROUND

Increasingly, women living with HIV are entering menopause (ie, cessation of menses for ≥1 year) and experiencing midlife symptoms. Menopausal hormone therapy (MHT) is first-line therapy for bothersome hot flashes and early menopause (ie, before age 45 years); however, its use in women living with HIV is poorly described. We conducted a cross-sectional assessment of MHT uptake and barriers to use in this group.

SETTING

This study was conducted across 3 Canadian provinces from 2015 to 2017.

METHODS

Perimenopausal and postmenopausal women living with HIV (35 years or older) in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study who answered questions related to MHT use were included. Univariable/multivariable logistic regression evaluated factors associated with MHT use, adjusted for age and contraindications.

RESULTS

Among 464 women, 47.8% (222 of 464) had a first-line indication for MHT; however, only 11.8% (55 of 464) reported ever using MHT and 5.6% (26 of 464) were current users. Only 44.8% had ever discussed menopause with their care provider despite almost all women having regular HIV care (97.8%). African/Caribbean/Black women had lower unadjusted odds of MHT treatment compared with White women [odds ratio (OR) 0.42 (0.18-0.89); P = 0.034]. Those who had discussed menopause with their care provider had higher odds of treatment [OR 3.13 (1.74-5.86); P < 0.001]. In adjusted analyses, only women having had a menopause discussion remained significantly associated with MHT use [OR 2.97 (1.62-5.61); P < 0.001].

CONCLUSION

Women living with HIV are seldom prescribed MHT despite frequent indication. MHT uptake was associated with care provider-led menopause discussions underscoring the need for care provider education on menopause management within HIV care.

摘要

背景

感染艾滋病毒的女性越来越多地进入更年期（即停经≥1年）并出现中年症状。更年期激素疗法（MHT）是治疗令人烦恼的潮热和早期更年期（即45岁之前）的一线疗法；然而，其在感染艾滋病毒女性中的使用情况鲜有描述。我们对该群体中MHT的使用情况及使用障碍进行了横断面评估。

背景

本研究于2015年至2017年在加拿大3个省份开展。

方法

纳入加拿大艾滋病毒女性性与生殖健康队列研究中年龄在35岁及以上、感染艾滋病毒的围绝经期和绝经后女性，她们回答了与MHT使用相关的问题。单变量/多变量逻辑回归评估与MHT使用相关的因素，并对年龄和禁忌症进行了调整。

结果

在464名女性中，47.8%（464名中的222名）有MHT的一线适应症；然而，只有11.8%（464名中的55名）报告曾使用过MHT，5.6%（464名中的26名）为当前使用者。尽管几乎所有女性都接受定期的艾滋病毒护理（97.8%），但只有44.8%的女性曾与她们的护理提供者讨论过更年期问题。与白人女性相比，非洲/加勒比/黑人女性接受MHT治疗的未调整几率较低[优势比（OR）0.42（0.18 - 0.89）；P = 0.034]。那些与护理提供者讨论过更年期问题的女性接受治疗的几率更高[OR 3.13（1.74 - 5.86）；P < 0.001]。在调整分析中，只有进行过更年期讨论的女性与MHT使用仍存在显著关联[OR 2.97（1.62 - 5.61）；P < 0.001]。