Resumen

Objective:The aim of this study was to compare the immunovirological response at 48 and 96 weeks from antiretroviral therapy (ART) initiation among premenopausal and postmenopausal HIV-infected women aged 45-60 years from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: Linear regression was used to assess mean differences in CD4 T-cell count and CD4% changes and logistic regression to estimate odds ratios (ORs) for CD4/CD8 ratio normalization (=1.0), achievement of Multiple T-cell marker recovery (MTMR - CD4 count>500 + CD4%>=29% + CD4/CD8 ratio>=1) and virological suppression from ART initiation. Regressions were adjusted for baseline (at ART initiation) CD4 count, baseline CD4%, baseline CD4/CD8, baseline viral load, calendar period of ART initiation. Results: Among 254 women included, 173 (68%) were premenopausal at ART initiation. Tenofovir disoproxil fumarate (TDF) + Emtricitabine (FTC) + Efavirenz (EFV) was the most frequent initial regimen, prescribed in 52 (30%) premenopausal and 23 (28%) postmenopausal women. Initial treatment regimens did not differ significantly between both groups. At ART initiation, there were no significant differences between premenopausal and postmenopausal women in CD4 counts (208 vs 183 cell/mm3; p=0.584), CD4 percentages (16.6% vs 15.0%; p=0.553) and CD4/CD8 ratio (0.30 vs 0.26; p=0.768), but premenopausal women had significantly lower viral loads than postmenopausal ones (4.7 vs 5.1 log copies/ml; P=0.021) Compared to premenopausal women, a higher proportion of postmenopausal women achieved a CD4/CD8 ratio =1 (ORadjusted: 3.69; 95% CI 1.91-7.11) and MTMR (ORadjusted: 4.27; 95% CI 1.35-13.49) at week 48; these differences lost statistical significance at week 96 (CD4/CD8 ratio =1: ORadjusted 0.70; 95% CI 0.17-2.91 and MTMR: ORadjusted 1.52; 95% CI 0.33-7.06). There were no significant differences in CD4 count changes from ART initiation (absolute and percentage), nor viral load suppression, between both groups.Conclusions: CD4/CD8 ratio=1 recovery and MTMR were better among postmenopausal women at 48 weeks of follow-up, although these differences were not significant at week 96, probably due to a lower number of women. Menopause did not have a negative impact on CD4 change from ART initiation or viral suppression.