Background Estrogen-based hormone therapy (HT) may have beneficial cardiovascular effects when initiated in early menopause. This has not been examined in women with HIV who have heightened immune activation and cardiovascular risks. Methods Among 609 post-menopausal women (1,234 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, 80% HIV+) 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% CI = [0.40, 0.80]; p < 0.01), 2.51 µm less progression of CIMT per year (95% CI = [-4.60, -0.41]; p = 0.02), and marginally lower incidence of plaque over ∼7 years (risk ratio = 0.38; 95% CI = [0.14, 1.03]; p = 0.06), 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.

中文翻译：

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感染和未感染艾滋病毒的女性的更年期激素治疗和亚临床心血管疾病


背景 在绝经早期开始，基于雌激素的激素疗法（HT）可能具有有益的心血管作用。尚未在免疫激活和心血管风险较高的感染艾滋病毒的女性中对此进行研究。方法 在妇女机构间艾滋病毒研究中，我们在 609 名绝经后妇女（1,234 人访问）中检查了曾经使用 HT（口服、贴片或阴道）与亚临床动脉粥样硬化的关系 - 颈动脉内膜中层厚度 (CIMT)、通过重复 B 型超声成像评估扩张性和斑块（2004-2013 年）。我们还研究了 HT 与免疫激活和 D-二聚体的横截面生物标志物的关联。统计模型根据社会人口统计学、行为和心脏代谢因素进行了调整。结果 基线时曾使用过 HT 的女性（平均年龄 = 51，80% HIV+）比从未使用过的女性年龄更大，而且更有可能是非西班牙裔白人，收入也更高。曾经使用过 HT 的女性的斑块患病率降低了 43%（患病率 = 0.57；95% CI = [0.40, 0.80]；p < 0.01），每年 CIMT 进展减少 2.51 µm（95% CI = [-4.60） ，-0.41]；p = 0.02），与从不使用协变量相比，约 7 年内斑块发生率略低（风险比 = 0.38；95% CI = [0.14, 1.03]；p = 0.06）；曾经使用过 HT 与扩张性无关。这些发现对于感染和未感染艾滋病毒的女性来说是相似的。曾经使用 HT 与血清 D-二聚体降低相关，但与协变量调整后的免疫激活生物标志物无关。结论 HT 可能会给 HIV 感染女性带来亚临床心血管益处。这些结果开始填补艾滋病毒携带者绝经期护理方面的知识空白，因为她们对激素的吸收率非常低。