Identifying unique life course health needs of women living with perinatally acquired HIV in the united states to inform health policy and care practice

The National Institute of Child Health and Human Development awarded Massachusetts General Hospital $4,140,802 on July 10, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to conduct metabolomics analysis and comparative health outcome research on women living with perinatally acquired HIV.

The research, titled the SHINE (Supporting Health in Life Course Needs of Women with Perinatally Acquired HIV) Study, performs plasma metabolomics on samples from women ages 30–40 who participated in the US-based HOPE Study (R01 HD101351). The study examines whether women with perinatally acquired HIV exhibit a unique metabolic signature of cardiovascular disease risk compared to women who acquired HIV later in life. The research also investigates menopause transition timing as a potentiating cardiovascular risk factor in women with perinatally acquired HIV relative to comparators with non-perinatally acquired HIV. The work informs health policy and care practice for the over 10,000 women in the United States born with HIV or infected in infancy who are now in their fourth and fifth decades of life.

Work is performed at Massachusetts General Hospital's Research Management Division in Boston, Massachusetts. The period of performance extends from July 10, 2026, through June 30, 2029. The assistance type is a Project Grant.

Abstract

In the maturing HIV epidemic, over 10,000 women in the united states (US) born with HIV or who acquired HIV in infancy are now reaching their 4TH and 5TH decades of life. While IT has been definitively established that women living with HIV experience higher risk of cardiovascular disease (CVD) compared to women who are HIV seronegative, CVD risk in the population of women with perinatally acquired HIV (PAHIV) has never been evaluated and requires an appropriate comparator group, women who acquired HIV later in life. Women with PAHIV have had a lifetime of exposure to the HIV virus, as well as alterations in their immune system caused by HIV, including chronic immune activation and inflammation, and years of receiving a variety of antiretroviral drugs. IT is likely that this population's risk of CVD is higher and occurs earlier than that observed in women with non-perinatally acquired HIV (NPAHIV). Importantly CVD risk in this group may reflect a unique metabolic pathway compared to women with NPAHIV. Additionally, other factors may potentiate CVD risk, such as earlier onset of menopause transition, as IT is already known that the general population of women with HIV experience menopause approximately 3 years earlier than women who are HIV-seronegative. But the timing of this known CVD risk factor has never been studied in women with PAHIV, again against an appropriate comparator group of women with NPAHIV. In the supporting health in life course needs of women with perinatally acquired HIV (SHINE) study, we propose performing metabolomics on plasma samples from women ages 30-40 years who participated in the US-based hope study (R01 HD101351), 31% of whom have PAHIV, with the remainder being women with NPAHIV, to determine if women with PAHIV have a unique metabolic signature of CVD risk compared to women with NPAHIV. This analysis will also allow US to determine if timing of emergence of a CVD risk metabolic signature occurs at an earlier age in women with PAHIV, a finding which would warrant specific CVD preventative care guidelines for the population of women with PAHIV. We will also assay anti-müllerian hormone from plasma samples of women ages 18-40 participating in the hope study, as this is a well-recognized marker of ovarian reserve, to determine if ovarian depletion, reflective of onset of menopause transition, occurs at an earlier age in women with PAHIV compared to women with NPAHIV. Lastly, we will establish a prospective observational cohort of 300 women living with HIV, ages 30-45 years, frequency matching women with PAHIV 2:1 to women with NPAHIV in order to understand prevalence and incidence of CVD events and menopause transition symptoms, and participant satisfaction with healthcare received for these issues. Significant strides in treatment and care of HIV have enabled women with PAHIV to reach the 4TH and 5TH decades of life. The proposed work of the SHINE study is designed to shed light on unique health risks of this population and identify whether tailored guidelines are needed to maximize the health and wellbeing of women with PAHIV and to inform the content of these guidelines, if required.