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15 November 2005

Volume 41, Number 10
Clinical Infectious Diseases 2005;41:1517–1524
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4110-0020$15.00
DOI: 10.1086/497270
HIV/AIDS MAJOR ARTICLE

HIV Infection, Drug Use, and Onset of Natural Menopause

Ellie E. Schoenbaum,1,2,3

Diana Hartel,1

Yungtai Lo,1

Andrea A. Howard,1,2

Michelle Floris‐Moore,1,2

Julia H. Arnsten,1,2 and

Nanette Santoro3

Departments of 1Epidemiology and Population Health and 2Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, and Department of 4Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York

Objective.To study the relationship of HIV infection and drug use with the onset of natural menopause.

Methods.Our analyses used the World Health Organization's definition of menopause (i.e., the date of the last menstrual period is confirmed after 12 months of amenorrhea) and baseline data from a prospective study. Semiannual interviews were conducted. Levels of HIV antibody and CD4+ cell counts were obtained. Menopause was identified at baseline or during 12 months of follow‐up. Women ingesting reproductive hormones were excluded. Logistic regression analyses were used to assess factors associated with menopause.

Results.Of 571 women, 53% were HIV infected, and 52% had used heroin or cocaine in the previous 5 years. The median age was 43 years (interquartile range [IQR], 40–46 years); 48.9% of the women were black, 40.4% were Hispanic, and 10.7% were white. The median body mass index was 29.1 kg/m2, and 90.4% of participants were current or former cigarette smokers. Menopause was identified in 102 women: 62 HIV‐infected women (median age, 46 years; interquartile range [IQR], 39–49 years) and 40 uninfected women (median age, 47 years; IQR, 44.5–48 years).

Factors independently associated with menopause included HIV infection (adjusted odds ratio [OR], 1.73; 95% confidence interval [CI], 1.075–2.795), drug use (adjusted OR, 2.633; 95% CI, 1.610–4.308), and physical activity (adjusted OR, 0.895; 95% CI, 0.844–0.950). Among HIV‐infected women, factors independently associated with menopause included CD4+ cell counts of >500 cells/mm3 (adjusted OR, 0.191; 95% CI, 0.076–0.4848) and 200–500 cells/mm3 (adjusted OR, 0.356; 95% CI, 0.147–0.813).

Conclusion.Our study shows that HIV infection and immunosuppression are associated with an earlier age at the onset of menopause. Whether early onset of menopause in HIV‐infected women increases their risk of osteoporosis and heart disease requires further study.

Received 27 April 2005; accepted 30 June 2005; electronically published 13 October 2005.

Reprints or correspondence: Dr. Ellie Schoenbaum, AIDS Research Program, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467 ().

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