Metabolic and Psychosocial Changes Associated with Menopause among Women with HIV

描述（由申请人提供）：在没有HIV的女性中，在绝经过渡期观察到显著变化，包括内脏脂肪和腰围增加，肌肉质量减少，以及脂质、葡萄糖代谢和骨密度的变化。HIV和潜在的抗逆转录病毒治疗的使用与类似的表现有关，如骨密度降低，脂质和葡萄糖代谢的变化，以及身体成分，尽管关于病毒如何影响或加剧绝经过渡期的这些变化知之甚少。绝经还与情绪状态的变化、生活质量下降以及未感染艾滋病毒的妇女出现血管炎症状有关。类似的心理社会指数在感染艾滋病毒的妇女中很常见，在更年期过渡期间可能会表现出来或恶化。这项拟议的研究将调查与绝经过渡相关的代谢和心理社会变化的患病率和程度，在基线和一年以上的艾滋病毒感染妇女与年龄，体重，月经状况和种族背景相似的妇女相比。具体而言，假设处于绝经过渡期的HIV阳性女性将表现出：1）内脏脂肪组织增加，瘦体重减少，血脂异常和葡萄糖代谢改变，2）随着时间的推移，骨丢失程度更大，骨丢失模式加速，3）与抑郁相关的骨质疏松症增加，生活质量降低，血管炎症状严重程度增加。这项新调查的结果将产生重要的数据，这些数据将有利于更年期过渡期艾滋病毒感染妇女的身体和心理健康。为了实现这些目标，候选人将参加教学课程，研究，指导和宣传活动的组合，除了科学研讨会和会议。候选人的机构支持提供了一个环境，有利于在与艾滋病毒有关的代谢和内分泌领域的世界知名专家的指导下开展面向患者的临床研究。K23职业发展奖的帮助将帮助候选人实现成为一名独立护士科学家的目标，并建立一个临床研究计划，重点关注与艾滋病毒感染妇女更年期过渡相关的代谢和心理社会指标。 公共卫生相关性：在未感染艾滋病毒的妇女中，在整个更年期过渡期间，代谢和心理社会参数都发生了重大变化。HIV和潜在的抗逆转录病毒治疗的使用与类似的代谢和心理表现有关，尽管关于病毒如何影响或加剧绝经过渡期的这种变化知之甚少。这项横断面和纵向调查将评估与基线和一年以上的绝经过渡期相关的代谢和心理社会指标，并与年龄、种族/民族、体重和月经状态相似的无艾滋病毒妇女进行比较。

DESCRIPTION (provided by applicant): Significant changes are seen across the menopause transition among women without HIV including increased visceral fat and waist circumference, reduced muscle mass, and changes in lipids, glucose metabolism and bone density. HIV and potentially antiretroviral therapy use have been associated with similar manifestations such as reduced bone density, changes in lipid and glucose metabolism, and body composition, though little is known regarding how the virus may influence or exacerbate such changes across the menopause transition. Menopause has also been associated with changes in mood state, decreased quality of life, and presence of vasomotor symptoms among women without HIV. Similar psychosocial indices are common among women with HIV, and may manifest or worsen during the menopause transition. The proposed study will investigate the prevalence and extent of both metabolic and psychosocial changes associated with the menopause transition at baseline and over one year among women with HIV compared to women without HIV of similar age, weight, menstrual status, and ethnic background. Specifically, it is hypothesized that HIV positive women in the menopause transition will demonstrate: 1) increased visceral adipose tissue, reduced lean body mass, dyslipidemia, and alterations in glucose metabolism, 2) a greater degree of bone loss and an accelerated pattern of bone loss over time, 3) increased symptomatology related to depression, reduced quality of life, and increased severity of vasomotor symptoms. Findings from this novel investigation will generate important data that will benefit both the physical and psychosocial health of women with HIV during the menopause transition. To achieve these aims, the candidate will participate in a combination of didactic coursework, research, mentorship and advisement activities, in addition to scientific symposia and conferences. The candidate's institutional support provides an environment that is conducive to conducting patient-oriented clinical research under the mentorship of a world renowned expert in the area of HIV-related metabolics and endocrinology. The assistance of the K23 career development award will help the candidate fulfill her goal of becoming an independent nurse scientist, and establish a program of clinical research that will focus on metabolic and psychosocial indices associated with the menopause transition among women with HIV. PUBLIC HEALTH RELEVANCE: Significant changes in both metabolic and psychosocial parameters are seen across the menopause transition among women without HIV. HIV, and potentially antiretroviral therapy use have been associated with similar metabolic and psychological manifestations, though little is known regarding how the virus may influence or exacerbate such changes across the menopausal transition. This cross-sectional and longitudinal investigation will evaluate metabolic and psychosocial indices associated with the menopause transition at baseline and over one year among women with HIV compared to women without HIV who are similar in age, race/ethnicity, weight and menstrual status.