The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV

ABSTRACT

Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance.

We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression.

Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms.

Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.

KEYWORDS:

• Menopause
• ageing
• women
• hiv
• adherence
• clinic attendance

Acknowledgements

We would like to thank the PRIME Study Expert Advisory Group: Comfort Adams, Jane Anderson, Mwenza Blell, Jonathan Elford (Chair), Janine MacGregor-Read, Fiona Pettitt, Janice Rymer, Jane Shepherd, Lorraine Sherr and Emily Wandolo; and the PRIME Study recruiting sites: Barking Community Hospital (Rageshri Dhairyawan, Emma Macfarlane, Sharmin Obeyesekera, Cecelia Theodore); Barts Hospital NHS Trust (James Hand, Helena Miras, Liat Sarner); Brighton and Sussex University Hospital (Yvonne Gilleece, Alyson Knott, Celia Richardson); Chelsea and Westminster Hospital (Mimi Chirwa, Ann Sullivan, Mini Thankachen, Sathya Visvendra); City of Coventry Health Centre (Sris Allen, Kerry Flahive); Guy’s and St Thomas' Hospital (Julie Fox, Julianne Iwanga, Annemiek DeRuiter, Mark Taylor); 10 Hammersmith Broadway (Sophie Hobday, Rachael Jones, Clare Turvey); Homerton University Hospital (Monica James, Sambasivarao Pelluri, Iain Reeves); Kings College Hospital (Sarah Barber, Priya Bhagwandin, Lucy Campbell, Leigh McQueen, Frank Post, Selin Yurdakul, Beverley White); Lewisham and Greenwich NHS Trust (Tarik Moussaoui, Melanie Rosenvinge, Judith Russell); Mortimer Market Centre (Tuhina Bhattacharya, Alexandra Rolland, Shema Tariq); New Cross Hospital Wolverhampton (Sarah Milgate, Anjum Tariq); North Manchester General Hospital (Claire Fox, Gabriella Lindergard, Andrew Ustianowski); Royal Free Hospital NHS Trust (Fiona Burns, Nargis Hemat, Nnenna Ngwu, Rimi Shah); Southend Hospital (Sabri Abubakar, John Day, Laura Hilton, Henna Jaleel, Tina Penn); St Mary’s Hospital (Angela Bailey, Nicola Mackie); University Hospital Birmingham (Reka Drotosne-Szatmari, Jan Harding, Satwant Kaur, Tessa Lawrence, Monika Oriak, Jonathan Ross); and West Middlesex Hospital (Kimberley Forbes, Ursula Kirwan, Shamela De Silva, Marie-Louise Svensson, Rebecca Wilkins). We are grateful for support from Positively UK and the UK-CAB. Finally, and most importantly, we thank all our participants for sharing their time and experiences so generously with us.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The PRIME Study was funded by the National Institute for Health Research (NIHR) in the form of a postdoctoral fellowship to ST (PDF-2014-07-071). Between March and December 2018 ST received salary support to continue work on this study, through a UCL/Wellcome Institutional Strategic Support Fund Flexible Support Award (204841/Z/16/Z). DS holds a clinical fellowship funded by the Wellcome Trust (102186/B/13/Z). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Welcome Trust, or the Department of Health.