Women with HIV experienced an increased frequency of hot flashes compared with women without HIV, exhibiting abnormal cardiac structure and function and higher systemic levels of soluble CD14, according to study results published in Open Forum Infectious Diseases.

In this observational, case-control study (ClinicalTrials.gov identifier: NCT02874703), researchers explored the relationship between hot flash frequency and systemic immune activation as well as subclinical cardiac pathology among women with HIV.

Women between 40 and 75 years of age were recruited. Researchers matched women with HIV (n=23) on antiretroviral therapy (ART) with women without HIV (n=19) based on age and BMI with no baseline demographic difference between groups.

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Women with HIV had a significantly higher number of days per week with hot flashes than women without HIV: 7 (interquartile range [IQR], 1.3-7.0) vs 0.8 (IQR, 0.0-2.1; P =.01). Furthermore, women with HIV still had a higher number of days per week with hot flashes after excluding women with menses in the past year (7.0 [IQR, 6.3-7.0] vs 0.4 [IQR, 0.0-2.3]; P =.007) and women with detectable anti-Müllerian hormone (7.0 [IQR, 2.4-7.0] vs 0.8 [IQR, 0.0-2.1]; P =.01).

Researchers noted longer duration of ART use among women with HIV experiencing hot flashes in the past year (21.2 [IQR, 16.0-22.7] vs 9.3 [IQR, 3.3-16.0] years; P =.03).

Among women with HIV and the whole group, women who experienced more than 1 hot flash per day had higher levels of soluble CD14 compared with women with 1 or fewer hot flashes per day (P =.004 and P =.02, respectively). Because soluble CD14 is a key marker of monocyte activation, this finding “suggests a possible link between monocyte activation and hot flash burden among [women with HIV]” the researchers noted.

In addition, years since onset of hot flashes among women with HIV was directly related to increased myocardial steatosis, measured by intramyocardial triglyceride content (ρ=0.80; P =.02), and decreased diastolic function, measured by left atrial passive ejection fraction (ρ=-0.70; P =.03).

This study was limited by its small sample size, recruitment from one geographic area, and women not being matched based on reproductive aging stage. Researchers were also not able to assess the potential effects of older ART agents on hot flash symptomatology among women with HIV.

“Additional research is required to improve our understanding of mechanisms underlying the relationship between hot flashes and [cardiovascular disease] risk indices among [women with HIV] and to determine if hot flashes represent a sex-specific risk factor for [cardiovascular disease] in [women with HIV],” the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Toribio M, Fulda ES, Chu SM, et al. Hot flashes and cardiovascular disease risk indices among women with HIV. Open Forum Infect Dis. 2021;8(2):ofab011. doi:10.1093/ofid/ofab011