Menopausal Hormone Therapy and Subclinical Cardiovascular Disease in Women With and Without Human Immunodeficiency Virus.

Background: Estrogen-based hormone therapy (HT) may have beneficial cardiovascular effects when initiated in early menopause. This has not been examined in women with human immunodeficiency virus (HIV), who have heightened immune activation and cardiovascular risks.
Methods: Among 609 postmenopausal women (1234 person-visits) in the Women's Interagency HIV Study, we examined the relationship of ever HT use (oral, patch, or vaginal) with subclinical atherosclerosis: carotid artery intima-media thickness (CIMT), distensibility, and plaque assessed via repeated B-mode ultrasound imaging (2004-2013). We also examined associations of HT with cross-sectional biomarkers of immune activation and D-dimer. Statistical models were adjusted for sociodemographic, behavioral, and cardiometabolic factors.
Results: Women (mean age, 51 years; 80% HIV positive) who ever used HT at baseline were older, and more likely to be non-Hispanic White and report higher income, than never-users. Women who ever used HT had 43% lower prevalence of plaque (prevalence ratio, 0.57 [95% confidence interval {CI}, .40-.80]; P < .01), 2.51 µm less progression of CIMT per year (95% CI, -4.60, to -.41; P = .02), and marginally lower incidence of plaque over approximately 7 years (risk ratio, 0.38 [95% CI, .14-1.03; P = .06), compared with never-users, adjusting for covariates; ever HT use was not associated with distensibility. These findings were similar for women with and without HIV. Ever HT use was associated with lower serum D-dimer, but not with biomarkers of immune activation after covariate adjustment.
Conclusions: HT may confer a subclinical cardiovascular benefit in women with HIV. These results begin to fill a knowledge gap in menopausal care for women with HIV, in whom uptake of HT is very low.
Competing Interests: Potential conflicts of interest. P. C. T. has received research funding from Merck (paid to institution) and Gilead to conduct sponsor-initiated clinical trials, unrelated to the current manuscript; grants or contracts (paid to institution), outside the submitted work, from Lilly; and royalties paid to self from UpToDate. A. A. A. has received consulting fees from Merck and Gilead; Merck and Gilead have also provided her institution with funding for her research. H. N. H. reports grants or contracts from the NIA, NIH (R01-AG059690 and R01-AG058691) and the Institute of Environmental Health, NIH (R01-ES031590), all outside the submitted work; payment or honoraria for a keynote lecture on menopause from the American Society of Reproductive Medicine; and data and safety monitoring board (DSMB) Chair, Flushing Reduction Associated With Nitrates (R01-AG050588) and DSMB for NIA-funded project (concluded). E. A. J. reports grants or contracts from the NIH outside the submitted work; royalties or licenses from UpToDate; consulting fees from the American College of Cardiology and McKesson; payment for expert testimony from DeBalse, Brown, Everly, LLP; and participation on a DSMB or advisory board for the NIH. K. A. reports additional grants from the NIH (paid to institution), outside the submitted work, and support for attending meetings and/or travel from the NIH (paid to institution). M. T. Y. reports support for the present manuscript from National Institute of Allergy and Infectious Diseases (K24 AI155230). M. L. A. reports grants or contracts from NIH MWCCS, outside the submitted work. A. S. reports grant funding from Gilead Sciences, outside the submitted work, and consulting fees from Gilead Sciences. I. O. reports grants or contracts from Merck, outside the submitted work. D. B. H. reports grants or contracts from the NIH (paid to institution), outside of the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
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