Summary
Recently, Mezones-Holguin et al. [1] reported the results of a study aimed at evaluating the association between menopausal status and female sexual function among mid-aged women with human immunodeficiency virus (HIV) infection. This was a cross-sectional study performed on 221 sexually active HIV-infected women aged 40 to 59, based on a secondary analysis of a three-hospital survey performed in Lima, Perú. Menopausal status was classified according to Stages of Reproductive Aging Workshop criteria (STRAW+10), the exposure variable was categorized as binary (non-postmenopausal and postmenopausal) and as multinomial (pre-, peri-, and postmenopausal). The 6-item Female Sexual Function Index (FSFI, total score 19 or less) was used to define low sexual function (LSF). In addition, socio-demographic and clinical variables were assessed that included age, used highly active antiretroviral therapy scheme, disease duration (time since diagnosis), depressive symptoms, and co-morbidities. Poisson generalized linear models were used. Studied women women had a median age of 47.0 years (interquartile range: 7.5), 25.3% were premenopausal, 25.8% were perimenopausal, and 48.9% were postmenopausal. The authors found that 64.3% had LSF. The frequency of LSF was 53.6% among non-postmenopausal women and 75.0% in postmenopausal ones. Postmenopausal status was associated with LSF in both the crude (cPR= 1.39; 95% CI: 1.13-1.71) and the adjusted regression models (aPR= 1.38; 95% CI: 1.12-1.71). The authors conclude that HIV-infected postmenopausal women have a higher prevalence of LSF than those non-postmenopausal ones, even when adjusting for multiple potential confounders.
Commentary
The HIV epidemic remains a significant public health concern [2]. Despite this, with new and effective antiretroviral therapies survival, quality of life has increased. Information regarding quality of life and sexuality among HIV-infected women is scarce, even if the prevalence of sexual problems is higher in HIV-infected women than non-infected ones. Some factors associated with low sexual functioning (LSF) in HIV-infected women include among the most important depression, irritability, anxiety, body image, obesity, stigma, and alcohol use [3]. Several studies have shown the negative impact of the menopause on sexual functioning among healthy women, with impairment of their quality of life. The authors aimed at evaluating the association between menopausal status and sexual function in sexually active heterosexual mid-aged women infected with HIV controlled by clinical and demographic variables (a first report a Peruvian and the Latin-American population). As expected, this study commented study found that LSF among the studied HIV-infected women was more common in postmenopausal as compared to premenopausal ones. This situation may even be worse if one takes int account that an increased probability of premature menopause and more severe menopausal symptoms have been observed in HIV-infected women [4,5]. In a previous multicenter Latin-American study that assessed sexual function using the 19-item FSFI in non-HIV infected mid-aged women included women from three Peruvian cities [6]. In this study, the authors reported the following LSF frequencies: Piura (32.1%), Lima (71.8%), and Cuzco (54.9%). With the present commented new study [1] their findings showed that postmenopausal status increased the probability (60%) of LSF among the HIV-infected participants, independently of clinical characteristics related to HIV and other co-morbidities. This study is the first to describe the association between menopausal status and LSF in HIV-infected Latin-American women living in their cultural and social environment in which sexual behavior may be different. The high frequency of LSF in this population highlights the need to tackle the factors associated with this condition to improve quality of life and sexuality of women with HIV, independent of their menopausal status (pre-, peri- or postmenopausal).
Finally, mid-aged HIV-infected women deserve appropriate care and research concerning menopause-related issues and sexuality, aside from antiretroviral management and social support.
Konstantinos Tserotas, MD
Tserotas Clinic, Panama City, Panama
References
- Mezones-Holguin E, Arriola-Montenegro J, Cutimanco-Pacheco V, et al. Low sexual function is associated with menopausal status in mid-aged women with human immunodeficiency virus infection. 2022;29(3):317-326.
https://pubmed.ncbi.nlm.nih.gov/35213519/ - GBD 2017 HIV collaborators. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV. 2019;6(12):e831-e859.
https://pubmed.ncbi.nlm.nih.gov/31439534/ - Huntingdon B, Muscat DM, de Wit J, Duracinsky M, Juraskova I. Factors Associated with General Sexual Functioning and Sexual Satisfaction among People Living with HIV: A Systematic Review. J Sex Res. 2020;57(7):824-835.
https://pubmed.ncbi.nlm.nih.gov/31755793/ - Calvet GA, Grinsztejn BG, Quintana Mde S, et al. Predictors of early menopause in HIV-infected women: a prospective cohort study. Am J Obstet Gynecol. 2015;212(6):765.e1-765.e13.
https://pubmed.ncbi.nlm.nih.gov/25557206/ - Ferreira CE, Pinto-Neto AM, Conde DM, Costa-Paiva L, Morais SS, Magalhães J. Menopause symptoms in women infected with HIV: prevalence and associated factors. Gynecol Endocrinol. 2007;23(4):198-205.
https://pubmed.ncbi.nlm.nih.gov/17505939/ - Blümel JE, Chedraui P, Baron G, et al.; Collaborative Group for Research of the Climacteric in Latin America (REDLINC). Sexual dysfunction in middle-aged women: a multicenter Latin American study using the Female Sexual Function Index. Menopause. 2009;16(6):1139-48.
https://pubmed.ncbi.nlm.nih.gov/19458559/
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