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Graham EE, Michala L, Hachfeld A, Moseholm E. Collection of menopause data in studies of women living with HIV: A systematic literature review. HIV Med 2024; 25:174-187. [PMID: 37776176 DOI: 10.1111/hiv.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES An increasing number of women living with HIV are transitioning through midlife and menopause. Women living with HIV may experience earlier menopause and a higher symptom burden than women without HIV, but more evidence is needed. Data collection on menopause in women living with HIV is scarce and often not standardized. We sought to assess how menopause data are collected in cohorts and studies of women living with HIV. METHODS This was a literature review conducted within the PubMed database. We included original studies and cohorts assessing menopause and/or menopausal symptoms in women living with HIV. Study characteristics and menopause data collection, including the definition of menopause, symptom assessment tools, and measurement of biomedical parameters, were noted and summarized systematically in data tables. RESULTS We included 40 articles describing 37 separate studies published between 2000 and 2023; 27 of these were conducted in high-income countries, the majority in the USA (n = 16). Ten studies were from low- and middle-income countries; four of these were conducted in Brazil. In 20 studies, menopause was defined according to the World Health Organization's definition of over 12 months of amenorrhea. Twelve studies used the Menopause Rating Scale to characterize menopausal symptoms, five studies used other specified symptom assessment tools, and 12 studies used a study-specific tool. CONCLUSIONS Menopause data collection in women living with HIV is heterogeneous. We propose that standardized tools should be used to enable comparisons between studies and countries, thereby improving the quality of research and clinical treatment. Further research into the validity of menopausal symptom scoring tools is warranted.
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Affiliation(s)
- Emma Eileen Graham
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lina Michala
- 1st Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Swann SA, King EM, Prior JC, Berger C, Mayer U, Pick N, Campbell AR, Côté HCF, Murray MCM. Longitudinal Assessment of Bone Mineral Density in Women Living With and Without HIV Across Reproductive Phases. J Acquir Immune Defic Syndr 2024; 95:197-206. [PMID: 37963371 DOI: 10.1097/qai.0000000000003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Women living with HIV commonly experience low areal bone mineral density (BMD), but whether this is affected by low ovarian hormonal states (prolonged amenorrhea or menopause) is unknown. We compared rates of BMD loss between women living with HIV and HIV-negative control women and investigated its association with low ovarian hormonal states. SETTING Women living with HIV were enrolled from Vancouver Canada and controls from 9 Canadian sites. METHODS This longitudinal analysis included age-matched women living with HIV in the Children and Women: AntiRetrovirals and Markers of Aging cohort and controls in the population-based Canadian Multicentre Osteoporosis Study. Rate of change/year in BMD at the total hip and lumbar spine (L1-L4) between 3 and 5 years was compared between groups, adjusting for sociodemographic and clinical variables. RESULTS Ninety-two women living with HIV (median [interquartile range] age: 49.5 [41.6-54.1] years and body mass index: 24.1 [20.7-30.8] kg/m 2 ) and 278 controls (age: 49.0 [43.0-55.0] years and body mass index: 25.8 [22.9-30.6] kg/m 2 ) were included. Total hip BMD loss was associated with HIV (β: -0.003 [95% CI: -0.006 to -0.0001] g/cm 2 /yr), menopause (β: -0.007 [-0.01 to -0.005] g/cm 2 /yr), and smoking (β: -0.003 [-0.006 to -0.0002] g/cm 2 /yr); BMD gain was linked with higher body mass index (β: 0.0002 [0.0007-0.0004] g/cm 2 /yr). Menopause was associated with losing L1-L4 BMD (β: -0.01 [-0.01 to -0.006] g/cm 2 /yr). Amenorrhea was not associated with BMD loss. CONCLUSIONS HIV and menopause negatively influenced total hip BMD. These data suggest women living with HIV require hip BMD monitoring as they age.
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Affiliation(s)
- Shayda A Swann
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Elizabeth M King
- Women's Health Research Institute, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, Vancouver, Canada
- Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Endocrinology and Metabolism, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Claudie Berger
- CaM os National Coordinating Centre, McGill University, Montreal, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, Vancouver, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Amber R Campbell
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Hélène C F Côté
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, Canada; and
- Edwin S.H. Leong Healthy Aging Program, University of British Columbia, Vancouver, Canada
| | - Melanie C M Murray
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
- Edwin S.H. Leong Healthy Aging Program, University of British Columbia, Vancouver, Canada
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Macdonald HM, Maan EJ, Berger C, Côte HCF, Murray MCM, Pick N, Prior JC. Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study. JBMR Plus 2023; 7:e10761. [PMID: 37614300 PMCID: PMC10443077 DOI: 10.1002/jbm4.10761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Heather M. Macdonald
- Active Aging Research TeamUniversity of British ColumbiaVancouverBCCanada
- Department of Family PracticeFaculty of Medicine, University of British ColumbiaVancouverBCCanada
| | - Evelyn J. Maan
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
| | - Claudie Berger
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Hélène C. F. Côte
- Department of Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- Centre for Blood ResearchFaculty of Medicine, University of British ColumbiaVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
| | - Melanie C. M. Murray
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Jerilynn C. Prior
- Women's Health Research InstituteVancouverBCCanada
- Centre for Menstrual Cycle and Ovulation Research, Department of Medicine, Division of EndocrinologyUniversity of British ColumbiaVancouverBCCanada
- School of Population and Public HealthFaculty of Medicine, University of British ColumbiaVancouverBCCanada
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Swann SA, King EM, Tognazzini S, Campbell AR, Levy SLA, Pick N, Prior JC, Elwood C, Loutfy M, Nicholson V, Kaida A, Côté HCF, Murray MCM. Age at Natural Menopause in Women Living with HIV: A Cross-Sectional Study Comparing Self-Reported and Biochemical Data. Viruses 2023; 15:v15051058. [PMID: 37243146 DOI: 10.3390/v15051058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Early menopause (<45 years) has significant impacts on bone, cardiovascular, and cognitive health. Several studies have suggested earlier menopause for women living with HIV; however, the current literature is limited by reliance on self-report data. We determined age at menopause in women living with HIV and socio-demographically similar HIV-negative women based on both self-report of menopause status (no menses for ≥12 months) and biochemical confirmation (defined as above plus follicle-stimulating hormone level ≥ 25 IU/mL). Multivariable median regression models assessed factors associated with menopause age, controlling for relevant confounders. Overall, 91 women living with HIV and 98 HIV-negative women were categorized as menopausal by self-report, compared to 83 and 92 by biochemical confirmation. Age at menopause did not differ significantly between groups, whether based on self-report (median [IQR]: 49.0 [45.3 to 53.0] vs. 50.0 [46.0 to 53.0] years; p = 0.28) or biochemical confirmation (50.0 [46.0 to 53.0] vs. 51.0 [46.0 to 53.0] years; p = 0.54). In the multivariable model, no HIV-related or psychosocial variables were associated with earlier age at menopause (all p > 0.05). Overall, HIV status per se was not statistically associated with an earlier age at menopause, emphasizing the importance of comparing socio-demographically similar women in reproductive health and HIV research.
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Affiliation(s)
- Shayda A Swann
- Experimental Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
| | - Elizabeth M King
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Shelly Tognazzini
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Amber R Campbell
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Sofia L A Levy
- Faculty of Science, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Chelsea Elwood
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON M5G 1N8, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Hélène C F Côté
- Experimental Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Edwin S.H. Leong Healthy Aging Program, University of University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Melanie C M Murray
- Experimental Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Women's Health Research Institute, Vancouver, BC V6H 3N1, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada
- Edwin S.H. Leong Healthy Aging Program, University of University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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5
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King EM, Swann SA, Prior JC, Berger C, Mayer U, Pick N, Campbell AR, Côté HCF, Murray MCM. Vitamin D intakes among women living with and without HIV in Canada. HIV Med 2023; 24:628-639. [PMID: 36597960 DOI: 10.1111/hiv.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patterns of vitamin D intake are relatively unexplored among women living with HIV, despite its importance for women's health. We compared vitamin D dietary and supplement intakes in women with HIV and population-based national controls and investigated barriers to intake. METHODS In this case-control study, women with HIV in the Children and Women: AntiRetrovirals and Markers of Aging (CARMA) cohort were matched with Canadian Multicentre Osteoporosis Study (CaMos) controls. Participants were queried for vitamin D in dairy consumption, supplementation/dosage, and sociodemographic variables. We assessed barriers to supplementation and factors associated with dietary intake by regression modelling. RESULTS Ninety-five women living with HIV were age-matched to 284 controls. Women with HIV had lower income and bone mineral density and were more likely to smoke, take multiple medications and be non-white. Vitamin D dietary intake was lower in women living with HIV versus controls [0.76 vs. 1.79 μg/day; adjusted odds ratio (aOR) for greater than or equal to median intake 0.29 (0.12-0.61), p = 0.002], but any supplementation was higher [62.2% vs. 44.7%; aOR = 3.44 (95% CI: 1.16-11.00), p = 0.03]. Total vitamin D intake was similar between groups. Smoking was associated with no supplementation; non-white ethnicity and low income were related to lower dietary intake. CONCLUSIONS Women living with HIV showed lower dietary vitamin D intake but higher supplementation rates, suggesting that care providers are promoting supplementation. Women living with HIV who smoke, have low incomes and are non-white may particularly benefit from targeted efforts to improve vitamin D intake.
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Affiliation(s)
- Elizabeth M King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Shayda A Swann
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Amber R Campbell
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
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6
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Khondoker CC, Kaida A, Marquez A, Campbell AR, Côté HCF, Albert AY, Pick N, Maan EJ, Russell EAB, Prior JC, Elwood C, Brophy J, Murray MCM. Factors associated with contraceptive use among women living with HIV in Canada: a controlled, cross-sectional study. Reprod Health 2022; 19:3. [PMID: 34986848 PMCID: PMC8729076 DOI: 10.1186/s12978-021-01312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multiple contraindications to combined hormonal contraceptives (CHC) use exist. The impact of these factors on contraceptive choice, particularly among women living with HIV (WLWH), is not well understood. We measured and compared the prevalence of contraceptive use and contraindications among WLWH and women not living with HIV (controls). METHODS We examined cross-sectional survey and medical chart data from 83 WLWH and 62 controls, aged 16-49 and sexually active, from 2013-2017. We compared the age-adjusted prevalence and types of contraceptives used in the last month and the proportion of women with CHC contraindications, including drug interactions, medical comorbidities, and smoking at ≥ 35 years old. All WLWH received care at an interdisciplinary, women-centred HIV clinic. RESULTS Compared to controls, WLWH were older (median [IQR)] 39 [34-43] vs 31 [23-41] years; p = 0.003), had less post-secondary education (37% vs 73%; p < 0.001), and more often had household income < $15,000/year (49% vs 30%; p = 0.006). WLWH trended to higher contraceptive prevalence than controls (80% vs 63%; p = 0.06 adjusted for age). Overall hormonal contraceptive use was similar. However, despite controlling for age, WLWH used CHC less (4% vs 18%; p = 0.006) than controls, and had more frequently undergone tubal ligation (12% vs 2%; p = 0.03). WLWH also experienced more CHC contraindications (54% vs 13%; p = 0.0001), including smoking at ≥ 35 years old (30% vs 6%; p = 0.0003) or a CHC-related drug interaction (all antiretroviral related) (25% vs 0%; p = 0.0001). CONCLUSIONS WLWH attending our interdisciplinary clinic used hormonal contraception at similar rates as controls, though with different types. Differences may reflect different distributions of CHC contraindications. CHC contraindications present barriers to accessing the full range of contraceptive choices for WLWH. Guidelines and education for care providers and WLWH regarding contraceptive choices and drug interactions are needed, especially when care is provided without the benefit of an interdisciplinary women-centered healthcare team.
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Affiliation(s)
- Chadni C Khondoker
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anna Marquez
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Amber R Campbell
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Department of Experimental Medicine, UBC, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Pathology & Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Neora Pick
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Emilie A B Russell
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, Department of Medicine, UBC, Vancouver, BC, Canada
| | - Chelsea Elwood
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, BC, Canada
| | - Jason Brophy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Melanie C M Murray
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
- Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital, E600B-4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
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7
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Macdonald HM, Maan EJ, Berger C, Dunn RA, Côté HCF, Murray MCM, Pick N, Prior JC. Deficits in bone strength, density and microarchitecture in women living with HIV: A cross-sectional HR-pQCT study. Bone 2020; 138:115509. [PMID: 32599222 DOI: 10.1016/j.bone.2020.115509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE With the advent of combined antiretroviral therapy (cART), life expectancy has increased among persons living with HIV, but so too has risk for comorbidities including osteoporosis and fragility fracture. To explore whether HIV status and cART influence three-dimensional measures of BMD, bone microarchitecture and strength we aimed to compare these outcomes between women living with HIV (WLWH; n = 50; 50.4 ± 1.2 years, 44% postmenopausal) and without HIV (controls; n = 50; 51.8 ± 1.2 years, 52% postmenopausal). METHODS Outcomes were lumbar spine, total hip and femoral neck areal BMD by DXA; distal radius and tibia trabecular BMD, thickness and number, and cortical BMD and area by HR-pQCT; and finite element analysis-derived bone strength (failure load). Multivariable regression analysis compared bone outcomes between groups adjusting for known osteoporosis risk factors. Within WLWH, we examined associations between bone outcomes and HIV-related factors including disease severity and cART duration. RESULTS WLWH were diagnosed 20 ± 4 years ago, were on cART for 123 ± 37 months and 80% had HIV plasma viral load <40 copies/mL. For women ≥50 years (n = 61), total hip aBMD T-Score was lower among WLWH than controls. Adjusted distal radius trabecular BMD and thickness and distal tibia trabecular BMD and failure load were 8-19% lower in WLWH than controls (p < 0.05). Cortical BMD and area did not differ between groups at either site. Lifetime cART duration and current plasma viral load were not associated with bone outcomes in WLWH; however, previous treatment with tenofovir was negatively associated with distal radius trabecular BMD and trabecular number and LS aBMD T-score. CONCLUSIONS WLWH have compromised BMD, bone microarchitecture and strength vs. controls of similar age and reproductive status. Treatment with tenofovir may contribute to bone deficits in WLWH.
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Affiliation(s)
- Heather M Macdonald
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Blvd, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2735 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada.
| | - Evelyn J Maan
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada.
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec H3H 2R9, Canada.
| | - Rachel A Dunn
- Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; Centre for Blood Research, University of British Columbia, 4302-2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; Centre for Blood Research, University of British Columbia, 4302-2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Melanie C M Murray
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Infectious Diseases, University of British Columbia, 328C, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada.
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Infectious Diseases, University of British Columbia, 328C, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada.
| | - Jerilynn C Prior
- Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Endocrinology, University of British Columbia, Gordon and Leslie Diamond Centre, 2775 Laurel Street, 4th Floor, Vancouver, British Columbia V5Z 1M9, Canada; Centre for Menstrual Cycle and Ovulation Research, The Gordon and Leslie Diamond Health Care Centre, Room 4111 - 4th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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