@article{88e8c1e91f0644c99a79427fa65df6f9,
title = "Reproductive Aging and Hepatic Fibrosis Progression in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Women",
abstract = "Background. Severity of hepatic fibrosis is greater in postmenopausal than in premenopausal women, perhaps owing to protective effects of estrogens. However, prior studies of estrogen and liver fibrosis lack serial fibrosis measures, adjustment for age, or longitudinal observations in coinfected populations. Methods. In a longitudinal cohort of women coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), we assessed fibrosis progression across reproductive age, using validated serum fibrosis markers, aminotransferase platelet ratio index (APRI) and fibrosis 4 (FIB-4). Fibrosis rate was evaluated within each woman as she transitioned from pre- to postmenopause, defined by a biomarker of ovarian function. Results. The median follow-up (n = 405) was 9.1 years (interquartile range, 5.0-15.2 years), with a median menopausal age of 49 years (47-52 years). When fully controlled for chronologic aging, the fibrosis progression rate was accelerated during perimenopause, as shown using FIB-4 (0.12 units per year faster than during premenopause; 95% confidence interval [CI], .02-.21; P = .01) and APRI (0.05 units per year faster; ?.002 to .09; P = .06). Accelerated fibrosis was also observed during postmenopause compared with premenopause, for FIB-4 (0.14 units per year faster; 95% CI, ?.01 to .29; P = .07) and APRI (0.07 units per year faster; ?.003 to .15; P = .06). Accelerated fibrosis in perimenopause persisted after adjustment for Hispanic ethnicity, antiretroviral use, and alcohol (0.10 FIB-4 units per year faster than during premenopause; 95% CI, .008-.20; P = .03). Conclusions. In HIV/HCV-coinfected women, hepatic fibrosis accelerates with reproductive aging. Accelerated fibrosis begins in perimenopause, highlighting a previously unrecognized group of women at increased risk for advanced fibrosis and associated complications. Longitudinal analyses of fibrosis rates across reproductive age should be conducted in non-HCV-related liver diseases, given potential implications in a broader spectrum of women.",
keywords = "anti-mllerian hormone, fibrosis markers, hepatic scarring, hormones, menopause",
author = "Monika Sarkar and Dodge, {Jennifer L.} and Greenblatt, {Ruth M.} and Kuniholm, {Mark H.} and Jack Dehovitz and Michael Plankey and Andrea Kovacs and French, {Audrey L.} and Seaberg, {Eric C.} and Igho Ofotokun and Margaret Fischl and Edgar Overton and Erin Kelly and Peter Bacchetti and Peters, {Marion G.}",
note = "Funding Information: Financial support. The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases, by site as follows: University of Alabama, Birmingham and University of Mississippi Medical Center (UAB-UMMC) WIHS (principal investigators, Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker; grant U01-AI-103401; Atlanta WIHS (I. O. and Gina Wingood; grant U01-AI-103408; Bronx WIHS (Kathryn Anastos; grant U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson; grant U01-AI-031834; Chicago WIHS (Mardge Cohen and A. L. F.; grant U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye; grant U01-AI-034994; Miami WIHS (M. F. and Lisa Metsch; grant U01-AI-103397; UNC WIHS (Adaora Adimora; grant U01-AI-103390; Connie Wofsy Women{\textquoteright}s HIV Study, Northern California (R. M. G., Bradley Aouizerat, and Phyllis Tien; grant U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub; grant U01-AI-042590; and Southern California WIHS (Joel Milam; grant U01-HD-032632 (WIHS I–WIHS IV). The WIHS receives additional cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute on Mental Health. Targeted supplemental funding for specific projects is provided by the National Institute of Dental and Craniofacial Research, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Deafness and other Communication Disorders, and the NIH Office of Research on Women{\textquoteright}s Health. WIHS data collection is supported by the University of California, San Francisco, Clinical and Translational Research Awards (CTRA) (grant UL1-TR000004) and Atlanta CTRA (grant UL1-TR000454). This work is also supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (K23 grant DK111944 to M. S.) and NIDDK (R21 grant A1088351 to M. P.).",
year = "2017",
month = nov,
day = "15",
doi = "10.1093/cid/cix643",
language = "English (US)",
volume = "65",
pages = "1695--1702",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "10",
}