Low genitourinary tract risks in women living with the human immunodeficiency virus

This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in perimenopausal and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side-effects or toxicity of ARTs, and opportunistic infections. Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.

Automated summary

This review examines the clinical associations between specific low genitourinary tract clinical conditions in perimenopausal and postmenopausal women living with HIV. Despite appropriate antiretroviral therapy, these women may experience menstrual dysfunction, vaginal microbiome alterations, vaginal dryness, low sexual function, and increased risks of certain cancers and infections. Furthermore, menstrual dysfunction and early menopause could contribute to a higher risk of vascular atherosclerosis and osteoporosis. It is important to manage these risks and complications related to hormone dysfunction and early menopause in WLHIV.