Menopause is associated with faster increases in insulin resistance in women with HIV
Year: 2025
Type: article
Abstract: BACKGROUND: Switching to an integrase strand transfer inhibitor (INSTI) during the menopausal transition has been associated with accelerated increases in visceral obesity, a risk factor for insulin resistance. Whether switching to an INSTI modifies the association of HIV and menopause with insulin resistance is unknown. METHODS: From 2006 to 2019, 389 nonpregnant women with HIV (WWH) [133 who switched to an INSTI (INSTI+); 256 who did not switch (INSTI-)] and 334 women without HIV from the Women's Interagency HIV study without diabetes or hepatitis C virus were included in the analysis. Mixed effect models evaluated the change in insulin resistance estimated through log HOMA-IR by HIV status by menopausal phase. We then compared trajectories by INSTI group. Menopausal phase was determined by anti-Müllerian hormone, a biomarker of ovarian reserve. RESULTS: Compared to women without HIV, INSTI+ WWH in premenopause had nonstatistically significant faster annual increases in HOMA-IR [difference in slope: 7.03%; 95% confidence interval (CI): -4.99 to 20.58] whereas INSTI- WWH had nonstatistically significantly faster annual decreases [-1.01% (95% CI: -7.34 to 5.75)]. In late perimenopause, INSTI+ and INSTI- had 4.87% (95% CI: -3.59 to 14.06) and 4.38% (95%CI: -3.10 to 12.44) nonstatistically significantly faster annual increases in HOMA-IR, respectively. In menopause, INSTI+ and INSTI- WWH had 9.18% (95% CI: 1.60 to 17.33) and 11.28% (95% CI: 3.27 to 19.91) statistically significant faster annual increases in HOMA-IR than women without HIV. There was no statistically significant difference between INSTI+ and INSTI- in any menopausal phase. CONCLUSION: Regardless of switching to an INSTI or not, WWH in late perimenopause and menopause have faster increases in insulin resistance when compared to women without HIV. Diabetes screening and prevention in midlife WWH is imperative.
Source: AIDS
Institutions: University of California, San Francisco, Emory University, University of Mississippi Medical Center, University of Miami, Albert Einstein College of Medicine, University of North Carolina at Chapel Hill, Johns Hopkins University, Hektoen Institute, Georgetown University Medical Center, State University of New York, SUNY Downstate Health Sciences University
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Translational Biomedical Science Training Grant, Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS), HIV, HCV, and gender effects on Liver, Bone, and Vascular Health, Clinical and Translational Science Institute, University of Miami Developmental HIV/AIDS Mental Health Research Center (D-ARC), Institutional Career Development Core, Johns Hopkins Institute for Clinical and Translational Research, University of Pittsburgh MACS/WIHS CCS, MACS/WIHS -CCS, The Synergistic Effects of Menopause and HIV on Cardiovascular Disease Risk in Women, Emory Specialized Center of Research Excellence (SCORE) on Sex Differences, ERC Einstein-Rockefeller-CUNY Center for AIDS research, SF Bay Area MACS/WIHS Combined Cohort Study, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Mentoring in Sex and Gender-informed Multidisciplinary Research on Cardiometabolic Comorbidities in Persons with HIV, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, Northwestern CORE Clinical Research Site: Trans-omics for HIV/AIDS Research, Los Angeles CRS for the MACS/WIHS Combined Cohort Study, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, MACS/WIHS Combined Cohort Study: Cook County Clinical Research Site (CC_CRS), SPPACE INSTI Study: Sex-specific Predictors, Pathways, And Cardiometabolic Effects of Weight Gain Associated with Integrase Strand-Transfer Inhibitors, The University of North Carolina Center for AIDS Research, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, Atlanta MACS/WIHS Combined Cohort Study Clinical Research Site, UAB-MISS MACS/WIHS Combined Cohort Study, Miami Center for AIDS Research, UCLA Clinical and Translational Science Institute, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W4414993560
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