Considerations for the long-term management of women living with HIV in Europe.

The average age at which women are first diagnosed with HIV is increasing and, due to advances in antiretroviral therapy (ART), women are living with HIV for longer. Once regarded as a fatal disease of young males, HIV is now considered a lifelong chronic condition affecting both men and women into older age. This raises questions for the long-term management of women living with HIV in Europe, such as how age affects the ART response, what the consequences are of long-term ART, and whether the comorbidities of ageing and menopause are different in women with HIV compared with men or uninfected women. Non-AIDS-related events, such as cancer, are increasingly responsible for the deaths of women with HIV, and European guidelines now recommend that they undergo regular screening for breast, cervical and colorectal cancer, and vaccination for human papillomavirus. The other major outcome of the greater life expectancy of women living with HIV is that a greater number are reaching menopause. Some studies suggest that HIV infection is linked with earlier onset of menopause and altered menopausal symptomatology. Many questions remain, and there is a need for more studies addressing ageing and sustained ART use in women living with HIV in Europe.