Women aging with Human Immunodeficiency Virus (HIV) are nearly five times more likely than women without HIV to experience early menopause (i.e., before age 45). It is unclear why women living with HIV (WLWH) undergo early menopause, but it is known that these women have irregular menstrual cycles and several periods of prolonged amenorrhea. Previous studies used self-reported prolonged amenorrhea for at least 12 months to define menopause. This may have misclassified menopausal status because these studies did not consider whether women resumed menses after prolonged amenorrhea, nor did they use an objective biomarker to confirm menopause. Antimullerian hormone (AMH) is the most objective and reliable biomarker of menopausal transition, and thus can be used to confirm age of menopause among WLWH. An AMH level <0.08 ng/ml is recognized as undetectable and shown among WLWH to be predictive of menopause approximately 3-5 years before final menstrual period. Research suggests that viral load and CD4+ count may be related to the early menopause, but there is less definitive research on the role of antiretroviral therapy (ART). There is a clinical and public health need to identify when WLWH are transitioning to menopause in order to distinguish whether ART is associated with early menopause.
The specific aims are to: confirm age at menopause (Aim 1); determine if WLWH are more likely than uninfected women to experience menopause earlier (Aim 2); and evaluate the association between ART use with early menopause among WLWH (Aim 3). The research strategy is to use the National Institutes of Health?s Women Interagency HIV Study (WIHS), a nationwide, multi-center, ongoing prospective cohort of WLWH and at-risk, uninfected women. WIHS began enrollment in 1993 (n=4,982), and data collected every six months include an in-depth interview, physical exam, and specimen collection. This data contain AMH measurements and has a long follow-up to observe menopausal transition. The expected clinical impact of this dissertation research is the advancement of scientific evidence of long- term health outcomes of WLWH as it pertains to transitioning into menopause. This dissertation addresses the Agency for Healthcare Research and Quality (AHRQ)?s priority populations by targeting women aging with HIV, particularly racial/ethnic minorities, the majority of the WIHS cohort. This research also addresses AHRQ?s research priority areas to improve safety by identifying the potential effects of ART use on early menopause, which can place women at risk for chronic medical conditions earlier than normal.
Women living with Human Immunodeficiency Virus (HIV) go through menopause earlier than the general population, and this increases their risk for long-term health outcomes. Using the Women?s Interagency HIV Study (WIHS), a nationwide, multi-center, longitudinal cohort of women with and at-risk of HIV enrolled from 1993 to present day, the goal of the proposed study is to examine whether antiretroviral treatment contributes to early menopause in women living with HIV (WLWH). The clinical and public health implications for health outcomes are that WLWH who are transitioning into menopause earlier than expected are at-risk of comorbidities associated with menopause earlier than normal.
