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Published on: May 9, 2025
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Switch to Integrase Strand Transfer Inhibitors During the Menopausal Transition Is Associated With Accelerated Body
Rebecca A Abelman1,2, Yifei Ma1, C Christina Mehta3
1Department of Medicine, University of California, San Francisco, California, USA.
Summary
Switching to integrase strand transfer inhibitors (INSTIs) during menopause accelerates waist circumference increases in women with HIV. Healthcare providers should consider menopausal status when prescribing INSTIs to manage body composition changes.
Area of Science:
- HIV/AIDS research
- Endocrinology
- Pharmacology
Background:
- Integrase strand transfer inhibitors (INSTIs) and menopause are linked to body composition changes in women with HIV (WWH).
- The interaction between INSTI use and menopausal transition regarding body composition in WWH is not well understood.
Purpose of the Study:
- To investigate the impact of switching to INSTI-based regimens on body composition changes during the menopausal transition in women with HIV.
- To compare body composition changes between women with HIV on INSTIs versus those not on INSTIs, and women without HIV.
Main Methods:
- 1131 virally-suppressed women with HIV (WWH) and 887 women without HIV (WWOH) were analyzed from 2006-2019.
- Mixed-effects models assessed changes in waist circumference (WC) and BMI across menopausal phases (premenopause, late perimenopause, menopause).
- Menopausal phase was determined using anti-Müllerian hormone levels.
Main Results:
- During premenopause, WC increases were similar across all groups.
- In late perimenopause, women switching to INSTIs (INSTI+) showed significantly faster WC increases compared to women not switching (INSTI-) and WWOH.
- In menopause, INSTI+ users experienced accelerated WC increases, peaking around 41-43 months, while INSTI- users had smaller increases.
Conclusions:
- Switching to INSTI-based regimens during late perimenopause and menopause is associated with increased waist circumference in women with HIV.
- Menopausal status is a critical factor to consider when initiating INSTI therapy in women with HIV to monitor and manage body composition.
- Further research into managing weight gain and body composition changes in WWH undergoing menopausal transition is warranted.
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