Metabolic and Psychosocial Changes Associated with Menopause among Women with HIV

描述（由申请人提供）：在未感染艾滋病毒的女性中，绝经过渡期的显著变化包括内脏脂肪和腰围增加，肌肉量减少，脂质，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骨密度降低、脂质和葡萄糖代谢以及身体成分的变化等类似表现有关，尽管人们对这种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妇女中，更年期也与情绪状态的变化、生活质量的下降和血管舒缩症状的出现有关。类似的社会心理指标在感染艾滋病毒的妇女中很常见，并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在基线和超过一年的时间内，与年龄、体重、月经状况和种族背景相似的未感染艾滋病毒的妇女相比，感染艾滋病毒的妇女与绝经期相关的代谢和社会心理变化的流行程度和程度。具体来说，假设HIV阳性妇女在绝经过渡期将表现出：1)内脏脂肪组织增加，瘦体重减少，血脂异常，葡萄糖代谢改变；2)更大程度的骨质流失，随着时间的推移，骨质流失的模式加速；3)与抑郁相关的症状增加，生活质量下降，血管舒缩症状的严重程度增加。这项新研究的发现将产生重要的数据，这些数据将有利于绝经期感染艾滋病毒的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、指导和咨询活动，以及科学专题讨论会和会议。候选人的机构支持为在hiv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导向的临床研究提供了有利的环境。K23职业发展奖的帮助将帮助候选人实现她成为一名独立的护士科学家的目标，并建立一个临床研究项目，重点研究与艾滋病毒感染妇女更年期过渡相关的代谢和社会心理指标。

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.