TreatmentUpdate
218

December 2016 

Viral load and some hormonal and metabolic issues in women

HIV infection has always been associated with reports of complex hormonal and metabolic abnormalities. Historically, the majority of such reports have been in HIV-positive men. A team of researchers in Vancouver, British Columbia, has been conducting several studies with women. In their latest analysis, the Vancouver researchers have focused on measuring a range of hormones and fatty substances in blood samples from HIV-positive women. They found that factors such as increasing age, BMI (body mass index) and, in some cases, having a high viral load prior to starting ART were associated with hormonal and metabolic abnormalities.

Study details

Researchers recruited 192 participants between 2008 and 2012 for their study. Upon entering the study, the average profile of participants was as follows:

  • age – 40 years
  • main ethno-racial groups: white – 44%; indigenous – 30%; black – 16%
  • most women were overweight
  • hepatitis C virus co-infection – 27% currently had HCV
  • use of tobacco – 52% were smokers
  • substance use – 34% used substances
  • lowest-ever CD4+ count – 190 cells/mm3
  • current CD4+ count – 470 cells/mm3
  • proportion with an HIV viral load of 100,000 copies/mL or higher – 47%
  • proportion with an HIV viral load of less than 50 copies/mL – 40%
  • duration of HIV infection – 11 years

Results—Hormonal and metabolic abnormalities

The researchers found that, overall, 58% of participants had at least one abnormal hormonal or metabolic test result.

Common hormonal/metabolic issues were as follows:

  • cholesterol or triglycerides – 43%
  • thyroid hormone(s) – 15%
  • blood sugar – 13%

Key factors associated with these abnormalities were increasing age (the older a woman, the greater the risk of having one or more of these abnormalities) and having had a high viral load (100,000 copies/mL or greater).

Focus on specific abnormalities and other associations with them

Thyroid hormones

Women who had a high viral load in the past and who were taking what the researchers termed “psychoactive medications” (drugs to help treat anxiety, depression, psychosis, sleeping problems and so on) were associated with an increased risk for having abnormal thyroid hormone levels. This should not be misinterpreted to mean that such drugs cause thyroid hormone problems. Rather, it is possible, likely even, that at least some of these women with abnormal thyroid hormone levels had mental health issues and were being treated for them. Indeed, symptoms of abnormal thyroid hormone levels (regardless of HIV infection) can include sleeping problems, anxiety and/or depression. Furthermore, these drugs do not generally cause thyroid hormone abnormalities in HIV-positive people.

Blood sugar

Participants who were older and overweight were more likely to develop problems controlling their blood sugar levels (this is seen in pre-diabetes and diabetes). A similar problem can be seen in HIV-negative women who are older and overweight.

Abnormal cholesterol and triglycerides

In general, as all people age, problems maintaining normal levels of cholesterol and triglycerides occur. The present study confirmed that these problems occur among HIV-positive women as they age.

Bear in mind

The present study was based on tests and assessments done at one point in time. Such analyses are cross-sectional and are good at finding associations but cannot prove cause and effect. That is, they cannot prove that some thing or event results in certain consequences. However, cross-sectional studies can be a useful step when initially exploring an idea. If the cross-sectional study finds something of interest to researchers, they can then engage in the laborious and time-consuming process of writing a grant proposal for a more robustly designed study and submitting the grant proposal to a funding agency in the hope that it gets highly rated when it is reviewed so it can be funded. According to sources in the scientific community, a large majority of grants (about 85%) submitted to major funding agencies, such as the Canadian Institutes of Health Research (CIHR) in Canada or the National Institutes of Health (NIH) in the U.S., do not get funded, even if such grants are about compelling biomedical issues.

The capacity of the researchers in the present study to extract more value from their analysis was also hobbled by their inability to determine whether the hormonal and metabolic problems that they found were present before or after HIV infection occurred.

A key finding from this study is the association between having a high viral load in the past and an increased risk for having a hormonal or metabolic abnormality. This intriguing connection needs to be explored in another study to confirm that it exists.

At the time the study was done, only about 40% of participants had a suppressed viral load. The Vancouver researchers should consider performing an updated analysis of viral loads, and if there are women whose viral loads are not less than 50 copies/mL, they should undertake research to explore the reasons for this. Such a study could be useful for clinics, community groups and health authorities to develop ways to help women in Vancouver achieve the better health that comes from an undetectable viral load.

Another finding was that 52% of the women were smokers. This figure is high. As smoking is associated with many harms and reduced survival, another possible future study in Vancouver could explore ways to help these women quit.

—Sean R. Hosein

REFERENCE:

Sokalski KM, Chu J, Mai AY, et al. Endocrine abnormalities in HIV-infected women are associated with peak viral load – the Children and Women: AntiRetrovirals and Markers of Aging (CARMA) Cohort. Clinical Endocrinology (Oxf). 2016 Mar;84(3):452-62.