Perspective

Menopause worsens fatigue, muscle aches in women with HIV

Researchers at Columbia University found evidence that fatigue and muscle aches — two of the most common symptoms among patients with HIV — are exacerbated by menopause.

Their study underscores the need for health care providers to consider menopause when treating the often-overlooked aging HIV population, according to Rebecca Schnall, PhD, RN, Mary Dickey Lindsay Associate Professor of Disease Prevention and Health Promotion at Columbia University School of Nursing, and colleagues.

“Given the shifting demographics in the HIV epidemic, our findings are very salient for people living with HIV and for their health care providers,” Schnall said in a press release. “If health care providers can better predict, identify and manage the symptoms that are most burdensome to women living with HIV, they can improve care for these women.”

Schnall and colleagues previously conducted a national survey of 1,342 men (n = 957) and women (n = 385) living with HIV in the United States to better understand how they are affected by HIV-associated non-AIDS conditions and symptoms. Survey respondents were recruited from February to August 2016 through banner ads on five social networking websites.

The most common symptoms participants reported were fatigue (8.6%), muscle aches (7.2%), depression (6.4%), anxiety (5.5%), difficulty staying asleep (5.5%) and difficulty falling asleep (5.3%). A gender-based analysis showed that women experienced a higher burden of fatigue (P = .013) and muscle aches (P = .004) compared with men.

In a follow-up survey, Schnall, Nancy Reame, PhD, RN, FAAN, director of the Pilot Studies Core at Columbia University’s Irving Institute for Clinical and Translational Research, and colleagues further examined the burden of symptoms among 222 women. They compared self-reported symptoms among women who went through natural menopause or who had a hysterectomy (n = 104) with those of menstruating women (n = 118).

“The study of differences in the way men and women experience HIV symptoms is an important emerging focus,” Reame, who also is Mary Dickey Lindsay Professor Emerita of Disease Prevention and Health Promotion in the Faculty of Nursing, said in a press release. “A number of studies have described menopause symptoms in women with HIV, but few have examined whether menopause might help explain the enhanced severity of HIV symptoms observed in women when compared to men.”

The survey results showed that postmenopausal women had higher burden scores for muscle aches/pains (P = .05), fatigue (P = .03) and trouble falling asleep (P = .04) vs. menstruating women. These results were independent of age, HIV duration and HIV-associated non-AIDS conditions, according to the researchers.

“To what extent this finding is confounded by an overlap between symptoms of menopause and consequences of HIV is difficult to untangle as this interaction is likely multidimensional and bidirectional, that is, menopause exacerbates HIV and HIV exacerbates menopause,” the researchers wrote. “As the number of women transitioning through menopause expands within the aging HIV cohort, the needs of this population are likely to require a multidisciplinary team of health care experts and new directions for HIV care management.” – by Stephanie Viguers

References:
Iribarren S, et al. AIDS Behav. 2017;doi:10.1007/s10461-017-1786-6.

Schnall R, et al. Menopause. 2018;doi:10.1097/GME.0000000000001083.

Disclosures: The authors report no relevant financial disclosures.

Researchers at Columbia University found evidence that fatigue and muscle aches — two of the most common symptoms among patients with HIV — are exacerbated by menopause.

Their study underscores the need for health care providers to consider menopause when treating the often-overlooked aging HIV population, according to Rebecca Schnall, PhD, RN, Mary Dickey Lindsay Associate Professor of Disease Prevention and Health Promotion at Columbia University School of Nursing, and colleagues.

“Given the shifting demographics in the HIV epidemic, our findings are very salient for people living with HIV and for their health care providers,” Schnall said in a press release. “If health care providers can better predict, identify and manage the symptoms that are most burdensome to women living with HIV, they can improve care for these women.”

Schnall and colleagues previously conducted a national survey of 1,342 men (n = 957) and women (n = 385) living with HIV in the United States to better understand how they are affected by HIV-associated non-AIDS conditions and symptoms. Survey respondents were recruited from February to August 2016 through banner ads on five social networking websites.

The most common symptoms participants reported were fatigue (8.6%), muscle aches (7.2%), depression (6.4%), anxiety (5.5%), difficulty staying asleep (5.5%) and difficulty falling asleep (5.3%). A gender-based analysis showed that women experienced a higher burden of fatigue (P = .013) and muscle aches (P = .004) compared with men.

In a follow-up survey, Schnall, Nancy Reame, PhD, RN, FAAN, director of the Pilot Studies Core at Columbia University’s Irving Institute for Clinical and Translational Research, and colleagues further examined the burden of symptoms among 222 women. They compared self-reported symptoms among women who went through natural menopause or who had a hysterectomy (n = 104) with those of menstruating women (n = 118).

“The study of differences in the way men and women experience HIV symptoms is an important emerging focus,” Reame, who also is Mary Dickey Lindsay Professor Emerita of Disease Prevention and Health Promotion in the Faculty of Nursing, said in a press release. “A number of studies have described menopause symptoms in women with HIV, but few have examined whether menopause might help explain the enhanced severity of HIV symptoms observed in women when compared to men.”

The survey results showed that postmenopausal women had higher burden scores for muscle aches/pains (P = .05), fatigue (P = .03) and trouble falling asleep (P = .04) vs. menstruating women. These results were independent of age, HIV duration and HIV-associated non-AIDS conditions, according to the researchers.

“To what extent this finding is confounded by an overlap between symptoms of menopause and consequences of HIV is difficult to untangle as this interaction is likely multidimensional and bidirectional, that is, menopause exacerbates HIV and HIV exacerbates menopause,” the researchers wrote. “As the number of women transitioning through menopause expands within the aging HIV cohort, the needs of this population are likely to require a multidisciplinary team of health care experts and new directions for HIV care management.” – by Stephanie Viguers

References:
Iribarren S, et al. AIDS Behav. 2017;doi:10.1007/s10461-017-1786-6.

Schnall R, et al. Menopause. 2018;doi:10.1097/GME.0000000000001083.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Pauline M. Maki

    Pauline M. Maki

    Although most people think of hot flashes as the major symptom of the menopause, muscle aches and joint pain are the most frequently cited symptoms. This study underscores the importance of considering biological sex and menopausal status as key factors that influence well-being in individuals living with HIV. Such observations are the first step in personalizing interventions to improve quality of life as individuals with HIV age.

    • Pauline M. Maki, PhD
    • Professor of psychiatry and psychology, University of Illinois at Chicago Director, Women’s Mental Health Research Associate director, Center for Research on Women and Gender Program director, K12 Building Interdisciplinary Research Careers in Women’s Health Program

    Disclosures: Maki reports no relevant financial disclosures.