The Body Covers: The 45th Annual Meeting of the Infectious Diseases Society of America
HIV-Infected Perimenopausal and Menopausal Women Have High Prevalence of Osteopenia/Osteoporosis and Risk Factors for Cardiovascular Disease
An Interview With Chia-Ching Wang, M.D.
October 6, 2007
This is Bonnie Goldman, Editorial Director of The Body PRO. I'm in San Diego at IDSA 2007, one of the year's HIV conferences. Right now, I'm in the poster session where researchers are standing in front of their posters. There's nothing like hearing the results of research directly from those who actually conducted the research. In this interview, the researchers will introduce themselves and then summarize their study. After their summary, I'll ask a few questions.
I'm Dr. Chia-Ching Wang. I'm from the Miriam Hospital in Providence, R.I. We're affiliated with Brown University. My study is on the characteristics of perimenopausal and menopausal women in our HIV menopause clinic.1 Our HIV menopause clinic is the first in the country, and it was established by Dr. Susan Cu-Uvin. We started two to three years ago because our clinic, as a whole, is aging. Our women are living longer due to the effectiveness of HAART [highly active antiretroviral therapy] and, because of that, they are able to live through menopause while being HIV infected.
We know that HIV and HAART produce a lot of metabolic abnormalities. It's very difficult to tease out the effects of aging from HAART and HIV. That's why we started this clinic, in order to better understand the interplay of those three.
We asked women to come in to complete a detailed history questionnaire; go through their menopausal symtoms and their risk factors for cardiovascular disease and osteoporosis; and make sure they get mammograms or Pap smears, as well as their DEXA [dual energy X-ray absorptiometry] scans. If they are on therapy, they are supposed to get lipid panels once a year, as well.
This is a summary of our results. We found that a lot of the women have cardiovascular disease risk factors. We haven't found any cardiovascular events yet.
Could you describe the risk factors?
What percentage of this population did you find smokes?
Very high, almost 40%. That's probably translatable to our entire clinic, as well. Both men and women in our clinic smoke quite a lot. They also have a lot of risk factors for osteoporosis: not only smoking, but also a lot of them used to have alcohol or substance abuse problems.
Our prevalence for osteopenia and osteoporosis are very high. Almost two thirds have abnormal bone scale results, and weight doesn't seem to protect them at all. This is in contrast to HIV-negative people.
Are these normal weight women?
These are actually more overweight women. They still have a lot of osteopenia and osteoporosis, which is very interesting.
Are they being given anything for it?
Yes. If they are osteopenic, we treat them with calcium supplements. If they are osteoporotic, we treat them with something called Fosamax [generic name: alendronate], and also the calcium supplements.
I know that it has been described that women with HIV sometimes have menopause early.2 Did you find that?
I think that in some of the earlier studies they have shown that. We know that minority women in this country tended to go through menopause one or two years early. It's very hard to distinguish. With the lower socioeconomic status, it's very hard to say exactly what it is due to. I think the jury is still out as to whether HIV itself causes earlier menopause.
So what's the next step?
Our next step is to really gather more complete data on all our women in the clinic and really be able to look at the associations between factors, like race.
What are the goals of this clinic? It's very interesting that there is a clinic like this. What does the clinic expect to do?
Well, to take better care of our women. I think HIV care is really becoming a primary care clinic instead of a specialty clinic.
How many women do you have in the menopause clinic?
So far, we've seen about 65. But we have a clinic with about 350 women, and their average age in the overall clinic is about 42. So we have a lot more women we'll be able to see in the future.
So you expect to continue studying them?
Well, thank you very much.
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