Swann Shayda A, King Elizabeth M, Pang Davi, Silva Marcela A P, Campbell Amber R, Prior Jerilynn C, Loutfy Mona, Kaida Angela, Côté Hélène C F, Murray Melanie C M
Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Women's Health Research Institute, BC Women's Hospital, Vancouver, British Columbia, Canada.
Open Forum Infect Dis. 2024 Aug 26;11(9):ofae493. doi: 10.1093/ofid/ofae493. eCollection 2024 Sep.
The menstrual cycle is a critical indicator of women's health. Early prolonged secondary amenorrhea increases risks for morbidity and mortality. Menstrual cycle research in women with HIV is inconsistent and often lacks an adequate comparison sample. We aimed to determine whether women with HIV have a higher lifetime prevalence of amenorrhea and whether this is independently associated with HIV and/or other biopsychosocial variables.
With data from 2 established HIV cohorts, participants assigned female at birth were eligible if aged ≥16 years, not pregnant/lactating, and without anorexia/bulimia nervosa history. Amenorrhea was defined by self-reported history of (1) no menstrual flow for ≥12 months postmenarche not due to pregnancy/lactation, medications, or surgery or (2) early menopause or premature ovarian insufficiency. Multivariable logistic regression models explored biopsychosocial covariates of amenorrhea.
Overall, 317 women with HIV (median age, 47.5 years [IQR, 39.2-56.4]) and 420 women without HIV (46.2 [32.6-57.2]) were included. Lifetime amenorrhea was significantly more prevalent among women with HIV than women without HIV (24.0% vs 13.3%). In the multivariable analysis, independent covariates of amenorrhea included HIV (adjusted odds ratio, 1.70 [95% CI, 1.10-2.64]), older age (1.01 [1.00-1.04]), White ethnicity (1.92 [1.24-3.03]), substance use history (6.41 [3.75-11.1]), and current food insecurity (2.03 [1.13-3.61]).
Nearly one-quarter of women with HIV have experienced amenorrhea, and this is associated with modifiable risk factors, including substance use and food insecurity. Care providers should regularly assess women's menstrual health and advocate for actionable sociostructural change to mitigate risks.
月经周期是女性健康的关键指标。早期长期继发性闭经会增加发病和死亡风险。关于感染艾滋病毒女性的月经周期研究结果不一致，且往往缺乏足够的对照样本。我们旨在确定感染艾滋病毒的女性闭经的终生患病率是否更高，以及这是否与艾滋病毒和/或其他生物心理社会变量独立相关。
利用两个已建立的艾滋病毒队列的数据，出生时被指定为女性的参与者如果年龄≥16岁、未怀孕/哺乳且无神经性厌食/神经性贪食病史，则符合条件。闭经的定义为自我报告的以下病史：(1)初潮后≥12个月无月经来潮，且非因怀孕/哺乳、药物或手术所致；或(2)早期绝经或卵巢早衰。多变量逻辑回归模型探讨了闭经的生物心理社会协变量。
总体而言，纳入了317名感染艾滋病毒的女性（中位年龄47.5岁[四分位间距，39.2 - 56.4]）和420名未感染艾滋病毒的女性（46.2岁[32.6 - 57.2]）。感染艾滋病毒的女性终生闭经的患病率显著高于未感染艾滋病毒的女性（24.0%对13.3%）。在多变量分析中，闭经的独立协变量包括艾滋病毒（调整后的优势比，1.70[95%置信区间，1.10 - 2.64]）、年龄较大（1.01[1.00 - 1.04]）、白人种族（1.92[1.24 - 3.03]）、物质使用史（6.41[3.75 - 11.1]）和当前粮食不安全状况（2.03[1.13 - 3.61]）。
近四分之一的感染艾滋病毒的女性经历过闭经，这与包括物质使用和粮食不安全在内的可改变风险因素相关。医护人员应定期评估女性的月经健康，并倡导采取可行的社会结构变革以降低风险。
