Estrogen Depletion And Immune Activation And Inflammation In Women With HIV
As women with HIV live longer, the menopausal transition plays a significant but often overlooked role in how HIV progresses. During this time, the natural decline in estrogen levels changes how the body’s defense system, both its immediate protective responses and its more targeted defenses, functions. Normally, estrogen helps certain immune cells, like plasmacytoid dendritic cells and natural killer cells, work effectively and keeps other immune cells, such as monocytes and macrophages, from becoming overly active. When estrogen levels drop during menopause, these beneficial effects are reversed, leading to higher levels of inflammatory substances in the body. Additionally, the loss of estrogen can cause T-cells, another type of immune cell, to become overactive and exhausted, weaken B-cell responses, and remove a natural brake on HIV activity. These changes can cause the hidden HIV, known as the HIV reservoir, to remain stable or even grow in women around menopause, which is a different pattern from what is often seen in men undergoing antiretroviral treatment. This shift contributes to ongoing inflammation, a greater risk of developing other health problems, and the continued presence of the HIV reservoir. Therefore, it is essential to incorporate the study of reproductive aging into HIV research and to explore hormone-based and anti-inflammatory treatments to improve the health of older women living with HIV.
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