XIX International AIDS Conference


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THPE040 - Poster Exhibition

Immunologic and virologic responses in HIV-positive women initiating highly active antiretroviral therapy before and after menopause

G. Calvet, L. Velasque, P. Luz, S.W. Cardoso, M. Derrico, R. Moreira, A. Andrade, A. Cytrin, E. Pires, V.G. Veloso, B. Grinsztejn, R. Friedman

Instituto de Pesquisa Clinica Evandro Chagas (IPEC), Rio de Janeiro, Brazil

Background: Response to antiretroviral treatment may be different according to menopausal status. We compared the effectiveness of first HAART in premenopausal and postmenopausal women.
Methods: ART-naïve women initiating HAART between January 2000 and December 2009 at the Instituto de Pesquisa Clinica Evandro Chagas Clinical Cohort in Brazil were studied. Women were defined as postmenopausal after 12 consecutive months of amenorrhea or bilateral oophorectomy. Menopausal status was captured by bi-annual structured gynecological questionnaires. CD4 cell counts and HIV-1 RNA viral load (VL) measurements were compared between pre and postmenopausal at 6, 12 and 24 months after HAART initiation. Women who modified/discontinued a drug class or died due to AIDS defining illness (ADI) were classified as failures. Quantitative variables between pre and postmenopausal women were compared by Wilcoxon test. Categorical variables were compared using χ2 or Fisher's exact test. The odds of virologic suppression (VS) (VL< 400 copies/mL) adjusting for baseline log 10 VL, baseline CD4, HAART regimen and concurrent ADI were compared using logistic regression. Linear model was used to access relationship between CD4 change and menopause.
Results: Among 383 women, 328 (85%) were premenopausal and 55 (15%) postmenopausal. Median age was lower for premenopausal (34 years/IQR: 28-40) than postmenopausal women (52 years/IQR: 48-55) (p< .001). Median pre-HAART CD4 count were 231 and 208 cells/mm3 (p=.14) in premenopausal and postmenopausal women respectively. No difference in the median pre-HAART VL was found (both 4.8 copies/mL). CD4 count changes were similar in pre and postmenopausal women at 6 and 12 months. At 24 months after HAART initiation, CD4 change among postmenopausal women was significantly lower than premenopausal women (p=.01). Overall, 63.7% achieved VS at 24 months with no statistical difference in VS at 6, 12 and 24 months between groups.

CharacteristicPremenopause (N=328)Postmenopause (N=55)Total (N=383)p-value
RaceWhite, N(%)136 (41.5)28 (50.9)164 (42.8).239
 Non-White,N(%)192 (58.5)27 (49.1)219 (57.2) 
HAART-based regimenPI, N(%)91 (27.7)18 (32.7)109 (28.5).518
 NNRTI, N(%)237 (72.3)37 (67.3)274 (71.5) 
Year of starting HAART2000-2004,N(%)118 (36.0)21 (38.2)139 (36.3).764
 2005-2009,N(%)210 (64.0)34 (61.8)244 (63.7) 
Concurrent ADIYes, N (%)68 (20.7)13 (23.6)81 (21.2).597
In clinical trialYes, N (%)125 (38.1)20 (36.4)145 (37.9).881
HysterectomyN (%)4 (1.2)10 (18.2)14 (3.6)<.001
[Demographic and clinical characteristics]

Change in CD4, median (IQR, cells/mm3)
6 months260101 (31-193)106 (69-201)101 (31-194).73
12 months273171 (76-290)147 (75-278)163 (72-285).42
24 months235273 (156-395)184 (116-282)262 (149-384).02
Virologic suppression, N (%)
6 months309189 (71.3)32 (72.7)221 (71.4).99
12 months310189 (71.3)33 (73.3)223 (71.2).94
24 months293164 (64.3)24 (60.5)188 (63.7).60
[HAART effectiveness: 6, 12, and 24 months]

 Virologic SuppressionCD4 Change
Time PointsNOR (95% CI)p-valueNCoefficients (standard error)p-value
6 months2301.00 (0.86-1.17).92219-7.6 (29.0).80
12 months2281.02 (0.87-1.19).75228-27.4 (31.2).31
24 months2101.02 (0.85-1.22).92199-97.8 (39.9).01
[Models: Viral Suppression and CD4 change]

Conclusions: Menopause status at HAART initiation influences long-term (24 months) immunologic response, but not short-term immunologic nor virologic outcomes.

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