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Cet intervenant :

"Ménopause et VIH: des particularités ?"

Dr I PoizotMartin

CHU Sainte Marguerite

Assistance publique Hôpitaux de Marseille

SFLS, Montpellier, Octobre 2016

Ménopause et infection par le VIH:

les questions

Age de survenue plus précoce?

Un sur-risque de comorbidités ?

Prévalence

Prévalence/ Intensité des signes associés?

THS en pratique ?

ovarienne -soitparépuisementdustockdefollicules -soitpost-chirurgical appeléepéri-ménopause delaproductionovariennes menstruations.

PY Scarabin, http://www.inserm.fr/thematiques/sante-publique/dossiers-d-information/menopause; Octobre 2012.

Ménopause et VIH:

Age de survenue plus précoce?

Lepoutreet al, Medecine,2010;6 DOI : 10.1684/med.2010.0508 (Grandevariabilitéindividuelle)

PY Scarabinhttp://www.inserm.fr/thematiques/sante-publique/dossiers-d-information/menopause; Octobre 2012.

Précoce: Entre 40 et 45 ans

Prématurée: Avant 40 ans

Ménopause et VIH:

Age de survenue plus précoce?

47,5ans.

02/10/2016 14:27Effects of human immunodeficiency virus on protracted amenorrhea and ovarian dysfunction. - PubMed - NCBI

Page 1 sur 2https://www.ncbi.nlm.nih.gov/pubmed?term=Obstet%20gynecol%202006%20108%3A1423-1431

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

LEVEL OF EVIDENCE:

See 1 citation in Obstet Gynecol 2006:

Obstet Gynecol. 2006 Dec;108(6):1423-31.

Effects of human immunodeficiency virus on protracted amenorrhea and ovarian dysfunction.

Cejtin HE, Kalinowski A, Bacchetti P, Taylor RN, Watts DH, Kim S, Massad LS, Preston-Martin S, Anastos K,

Moxley M, Minkoff HL.

Abstract

To characterize ovarian failure and prolonged amenorrhea from other causes in women who are both human immunodeficiency virus (HIV) seropositive and seronegative. This was a cohort study nested in the Women's Interagency HIV Study, a multicenter U.S. study of HIV infection in women. Prolonged amenorrhea was defined as no vaginal bleeding for at least 1 year. A serum follicle stimulating hormone more than 25 milli- International Units/mL and prolonged amenorrhea were used to define ovarian failure. Logistic regressions, chi2, and t tests were performed to estimate relationships between HIV-infection and cofactors with both ovarian failure and amenorrhea from other causes. Results were available for 1,431 women (1,139 HIV seropositive and 292 seronegative). More than one half of the HIV positive women with prolonged amenorrhea of at least 1 year did not have ovarian failure. When adjusted for age, HIV seropositive women were about three times more likely than seronegative women to have prolonged amenorrhea without ovarian failure. Body mass index, serum albumin, and parity were all negatively associated with ovarian failure in HIV seropositive women. HIV serostatus is associated with prolonged amenorrhea. It is difficult to ascertain whether the cause of prolonged amenorrhea is ovarian in HIV-infected women without additional testing. II-2. PMID: 17138776 DOI: 10.1097/01.AOG.0000245442.29969.5c [PubMed - indexed for MEDLINE]

Format: Abstract

1

Author information

PubMedObstet gynecol 2006 108:1423-1431

CejtinHE et al.

Ménopause et VIH:

Age de survenue plus précoce?

201 femmes VIH+ appariées sur 603 femmes séronégatives,

suivies pour infertilité CD4 bas et CV VIH non contrôlée sont significativement associés à une diminution de la réserve ovarienne

1. Ménopause et VIH:

Un dosage de la FSH

N Andanyet al

International Journal of Health2016:8 122

Ménopause et infection par le VIH:

les questions

Age de survenue plus précoce?

Un sur-risque de comorbidités?

Prévalence

Prévalence/ Intensité des signes associés?

THS en pratique?

February 2014 | Volume 9 | Issue 2 | e89299 GA Calvet et al Treatment ReVponVeV in AnWireWroviral TreaWmenW (ART) Pre- anT PoVW-menopauVal HIV-infecWeT PomenJ An AnalyViV from

ACTG SWuTieV

PUM3H Marlene Smurzynski, PhD3H anT Joseph J. Eron, MD1

1University of North Carolina, Chapel Hill, NC, US

2University of Rochester, Rochester, NY, US

3Harvard School of Public Health, Boston, MA, US

Abstract

Menopause may affect antiretroviral treatment (ART) response. Immunologic and virologic reVponVeV Wo ART were compareT in 220 pre- anT 47 poVW-menopauVal women enrolleT in Wwo ART- naive VWuTieV. CUangeV in CM4 counWV or HIV-1 RNA were Vimilar aW 24H 48H or 96 weekV. TreaWmenW-

Keywords

Introduction

Half of the individuals living with HIV/AIDS worldwide are women [1]. In 2006H 15% of newly TiagnoVeT caVeV of HIV in WUe UniWeT SWaWeV were in inTiviTualV above WUe age of 50 [2]. TUe number of maWure women wUo will become HIV-infecWeT or wUo will live wiWU HIV iV expecWeT Wo increaVe aV overall life expecWancy increaVeV. HIV-infecWeT women will Uave alreaTy unTergone or will unTergo WUe menopauVe WranViWion Turing WUe courVe of WUeir TiVeaVe. TUe TifferenceV beWween Uow HIV-infecWeT anT HIV-uninfecWeT women experience menopauVe are only recenWly unTer inveVWigaWion [3]. MeVpiWe WUeVe efforWVH WUere iV a pauciWy of informaWion regarTing iniWial WreaWmenW reVponVeV Wo anWireWroviral WUerapy (ART) in poVW- menopauVal women. Younger HIV-infecWeT women Uave UigUer CM4 counWV anT lower HIV-1 RNAH on averageH wUen compareT Wo age-maWcUeT HIV-infecWeT men in early TiVeaVe anT prior Wo receiving ART

AuWUor MiVcloVureV

received Honorarium from Merck, Roche, BMS, Tibotec, Virco Labs, Gilead.

All oWUer auWUorVJ No TiVcloVureVIconflicWV

NIH Public Access

Author Manuscript

Clin Infect Dis. Author manuscript; available in PMC 2010 August 1.

Published in final edited form as:

Clin Infect Dis

NIH-PA AuWUor ÓanuVcripW

NIH-PA AuWUor ÓanuVcripW

NIH-PA AuWUor ÓanuVcripW

Treatment ReVponVeV in AnWireWroviral TreaWmenW (ART) Pre- anT PoVW-menopauVal HIV-infecWeT PomenJ An AnalyViV from

ACTG SWuTieV

PUM3H Marlene Smurzynski, PhD3H anT Joseph J. Eron, MD1

1University of North Carolina, Chapel Hill, NC, US

2University of Rochester, Rochester, NY, US

3Harvard School of Public Health, Boston, MA, US

Abstract

Menopause may affect antiretroviral treatment (ART) response. Immunologic and virologic reVponVeV Wo ART were compareT in 220 pre- anT 47 poVW-menopauVal women enrolleT in Wwo ART- naive VWuTieV. CUangeV in CM4 counWV or HIV-1 RNA were Vimilar aW 24H 48H or 96 weekV. TreaWmenW-

Keywords

Introduction

Half of the individuals living with HIV/AIDS worldwide are women [1]. In 2006H 15% of newly TiagnoVeT caVeV of HIV in WUe UniWeT SWaWeV were in inTiviTualV above WUe age of 50 [2]. TUe number of maWure women wUo will become HIV-infecWeT or wUo will live wiWU HIV iV expecWeT Wo increaVe aV overall life expecWancy increaVeV. HIV-infecWeT women will Uave alreaTy unTergone or will unTergo WUe menopauVe WranViWion Turing WUe courVe of WUeir TiVeaVe. TUe TifferenceV beWween Uow HIV-infecWeT anT HIV-uninfecWeT women experience menopauVe are only recenWly unTer inveVWigaWion [3]. MeVpiWe WUeVe efforWVH WUere iV a pauciWy of informaWion regarTing iniWial WreaWmenW reVponVeV Wo anWireWroviral WUerapy (ART) in poVW- menopauVal women. Younger HIV-infecWeT women Uave UigUer CM4 counWV anT lower HIV-1 RNAH on averageH wUen compareT Wo age-maWcUeT HIV-infecWeT men in early TiVeaVe anT prior Wo receiving ART

AuWUor MiVcloVureV

received Honorarium from Merck, Roche, BMS, Tibotec, Virco Labs, Gilead.

All oWUer auWUorVJ No TiVcloVureVIconflicWV

NIH Public Access

Author Manuscript

Clin Infect Dis. Author manuscript; available in PMC 2010 August 1.

Published in final edited form as:

Clin Infect Dis

NIH-PA AuWUor ÓanuVcripW

NIH-PA AuWUor ÓanuVcripW

NIH-PA AuWUor ÓanuVcripW

KB Patterson et al

220 Pré Ménopause

47 Post Ménopause

328 Pré Ménopause

55 Post Ménopause

2. Ménopause et cART

sur la réponse immunovirologique

JM. Greiget al CurrOpinInfect Dis 2014,27:46-52

2. cARTet Ménopause: une surtoxicité?

M Greene et al J Am GeriatrSoc. 2014 March ; 62(3): 447-453

Ménopause et infection par le VIH:

les questions

Age de survenue plus précoce?

Un sur-risque de comorbidités?

Prévalence

Prévalence/ Intensité des signes associés?

THS en pratique?

Périménopause

Postménopause

Ménopause confirmée !

Risque Cardio-Vasculaire

Composition corporelle,

Dyslipidémie, HTA

Syndrome métabolique

Tissu osseux

Risque fracturaire

Dépression

Troubles vasomoteurs

(bouffées de chaleur, sueurs nocturnes,

Syndrome des jambes sans repos

Insomnie

Vie affective/ Santé sexuelle

Ménopause: les effets collatéraux

6-year cUangeV in boTy compoViWion in women aW miT-lifeJ ovarian

anT cUronological aging MaryFran Sowers, PhD1H Huiyong Zheng, PhD1H Kristin Tomey, PhD1H Carrie Karvonen- GuWierreYH ÓPH1H Mary Jannausch, MS1H Xizhao Li, MS1H Matheos Yosef, PhD1H anT James

SymonVH PUM1

1Department of NpiTemiology; UniverViWy of ÓicUigan ScUool of Public HealWU; Ann ArborH ÓI 48104

Abstract

Understanding WUe menopauVe aVVociaWion wiWU boTy weigUW iV imporWanW becauVe exceVV

weigUW increaVeV riVk for VWrokeH inciTenW carTiovaVcular TiVeaVeH carTiovaVcular morWaliWyH anT all-

cauVe morWaliWy among WUe miTTle-ageT. To examine cUronological age anT ovarian age anT conViTer Uow WUeVe coulT influence boTy ViYe anT compoViWion in miT-life women. community-based study. This report uses data from the Michigan SWAN site.

543 pre- or early perimenopausal African-American and Caucasian women aged

Waist circumference, fat mass and skeletal muscle mass, from bioelecWrical impeTanceH waV aVVeVVeT in 7 annual Verial meaVureV. Annual follicle-VWimulaWing Uormone (ŃSH) valueV were aVVayeT by NLISA. TUe final menVWrual perioT (ŃÓP) waV TefineT reWroVpecWively following 12 monWUV of amenorrUea. There was an absolute cumulative six-year increase in fat mass of 3.4 kg and a six-year TecreaVe in VkeleWal muVcle maVV of ~0.23 kg. TUere waV an abVoluWe cumulaWive Vix-year increaVe of ~5.7 cm in waiVW circumference. TUe logFSH change was positively correlated with log(fat mass)

cUange. PaiVW circumference increaVeT over WUe Wime perioTH buW one year following ŃÓPH WUe raWe

of increaVe VloweT. ŃaW maVV conWinueT Wo increaVe wiWU no cUange in raWe. Both time (chronological aging) and ovarian aging contributed to substantial cUangeV in boTy compoViWion (faW anT VkeleWal muVcle maVV) anT waiVW circumference. TUeVe cUangeVquotesdbs_dbs5.pdfusesText_9