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Menopause is associated with faster increases in insulin resistance in women with HIV; Editorial Comment
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Download the PDF here
Download the PDF here
Abelman, Rebecca A.a; Ma, Yifeia; Mehta, C. Christinab; Yang, Qianb; Xia, Fana; Brock, James B.c; Alcaide, Maria L.d; Sharma, Anjalie; Floris-Moore, Michellef; Topper, Elizabethg; Weber, Kathleen M.h; Kassaye, Seble G.i; Gustafson, Deborahj; Grunfeld, Carla; Lahiri, Cecile D.b; Tien, Phyllis C.a
AIDS march 2026
We found that WWH in late perimenopause and especially menopause had a faster increase in insulin resistance compared to women without HIV. Notably, this increase was independent of visceral obesity as assessed by waist circumference. Our findings suggest that during the menopausal transition, WWH are at greater risk for faster increases in insulin resistance, which could increase the risk for type 2 diabetes, and it is not related to the use of INSTIs.
In conclusion, we found that WWH in late perimenopause and menopause have faster increases in insulin resistance when compared to women without HIV, and this increase was independent of switching to an INSTI or tenofovir exposure. These findings suggest that diabetes screening and prevention in midlife WWH is imperative, regardless of ART regimen. Taken together, our findings suggest that there is neither a direct effect of INSTI on insulin resistance nor an indirect effect through visceral adiposity. Additional research is needed to understand the mechanism by which menopause affects insulin resistance.
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.
Menopause and metabolic risk in women with HIV: beyond antiretroviral therapy
Abrescia, Nicola
Pdf attached
AIDS March 2026
The story of HIV and ageing is increasingly a story of women. As more women live long enough to experience menopause, the metabolic consequences of reproductive aging will shape the next phase of HIV care. The study published in this issue underscores the urgency of a comprehensive, sex-specific approach, one that views menopause not as the end of reproductive life, but as the beginning of a new frontier in chronic disease prevention.
The challenge for clinicians and researchers alike is to move from documenting risk to mitigating it. Understanding how hormones, immunity, and ART converge to influence insulin resistance is not merely a scientific question, it is central to ensuring healthy longevity for women with HIV. Longitudinal cohorts such as MACS-WIHS offer unique opportunities to explore these mechanisms, particularly if future data collection captures hormonal therapy use, inflammatory markers, and cardiovascular outcomes alongside virological and immunological variables.
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