Metabolic and Psychosocial Changes Associated with Menopause among Women with HIV

描述(申请人提供)：在没有感染艾滋病毒的妇女的更年期过渡过程中，可以看到显著的变化，包括内脏脂肪和腰围增加，肌肉质量减少，以及血脂、葡萄糖代谢和骨密度的变化。艾滋病毒和潜在的抗逆转录病毒疗法的使用与类似的表现有关，如骨密度降低、脂肪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更年期过渡期间的这些变化知之甚少。在没有感染艾滋病毒的女性中，更年期也与情绪状态的变化、生活质量下降和血管舒缩症状的存在有关。类似的心理社会指标在艾滋病毒携带者中很常见，可能在更年期过渡期间表现出来或恶化。这项拟议的研究将调查艾滋病毒携带者与年龄、体重、月经状况和种族背景相似的非艾滋病毒妇女在基线和一年以上的更年期过渡中代谢和心理社会变化的患病率和程度。具体地说，假设处于更年期过渡阶段的HIV阳性女性将表现为：1)内脏脂肪组织增加，瘦体重减少，血脂异常，以及葡萄糖代谢改变，2)随着时间的推移，骨丢失程度更大，骨丢失加速，3)与抑郁相关的症状增加，生活质量下降，血管舒缩症状加重。这项新调查的发现将产生重要的数据，这些数据将有益于更年期艾滋病毒携带者妇女的身体和心理社会健康。为了实现这些目标，除了科学研讨会和会议外，候选人还将参加一系列教学课程、研究、指导和咨询活动。候选人的机构支持提供了一个环境，有利于在艾滋病毒相关代谢和内分泌学领域的世界知名专家的指导下进行以患者为中心的临床研究。K23职业发展奖的帮助将帮助候选人实现她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，专注于与艾滋病毒感染女性的更年期转变相关的代谢和心理社会指标。 公共卫生相关性：在没有感染艾滋病毒的妇女的更年期过渡过程中，代谢和心理社会参数都发生了重大变化。艾滋病毒和潜在的抗逆转录病毒疗法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更年期过渡期间的这种变化知之甚少。这项横向和纵向调查将评估艾滋病毒感染妇女与年龄、种族/民族、体重和月经状况相似的非艾滋病毒妇女在基线和一年以上的更年期过渡相关的代谢和心理社会指标。

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.