Use of antimüllerian hormone to predict the menopausal transition in HIV-infected women

BackgroundHIV infection has been associated with early menopausal onset, which may have adverse long-term health consequences. Antimüllerian hormone, a biomarker of ovarian reserve and gonadal aging, is reduced in HIV-infected women.ObjectiveWe sought to assess the relationship of antimüllerian hormone to age of menopause onset in HIV-infected women.Study designWe used antimüllerian hormone levels measured in plasma in 2461 HIV-infected participants from the Women's Interagency HIV Study to model the age at final menstrual period. Multivariable normal mixture models for censored data were used to identify factors associated with age at final menstrual period.ResultsHigher antimüllerian hormone at age 40 years was associated with later age at final menstrual period, even after multivariable adjustment for smoking, CD4 cell count, plasma HIV RNA, hepatitis C infection, and history of clinical AIDS. Each doubling of antimüllerian hormone was associated with a 1.5-year increase in the age at final menstrual period. Median age at final menstrual period ranged from 45 years for those in the 10th percentile of antimüllerian hormone to 52 years for those in the 90th percentile. Other factors independently associated with earlier age at final menstrual period included smoking, hepatitis C infection, higher HIV RNA levels, and history of clinical AIDS.ConclusionAntimüllerian hormone is highly predictive of age at final menstrual period in HIV-infected women. Measuring antimüllerian hormone in HIV-infected women may enable clinicians to predict risk of early menopause, and potentially implement individualized treatment plans to prevent menopause-related comorbidities and to aid in interpretation of symptoms

Relationships between gestational diabetes (GDM) and age (Fig 1A), weight (Fig 1B), free thyroxine (fT4) (Fig 1C), and thyrotropin (TSH) (Fig 1D).

<p>Open circles represent percents of GDM cases at each decile of the variable shown on the X-axis. Solid lines indicate unadjusted slopes of the respective relationships; p-values indicate slope significance. The dotted line in Fig 1C shows the slope of the fT4/GDM relationship, after adjustment for age, weight, and TSH.</p

Extent to which variables that differ significantly between women with and without gestational diabetes might influence fT4 concentration (9,079 women without gestational diabetes).

<p>Extent to which variables that differ significantly between women with and without gestational diabetes might influence fT4 concentration (9,079 women without gestational diabetes).</p

Schematic diagram depicting how caloric intake and deiodinase activity fit into relationships shown in Fig 2.

<p>Higher caloric intake (C) reflects higher weight (A) and induces higher deiodinase activity (D) [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149065#pone.0149065.ref032" target="_blank">32</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149065#pone.0149065.ref034" target="_blank">34</a>]. Lower fT4 (E) and higher T3/T4 ratios (F) occur as a consequence of higher deiodinase activity and are associated with both insulin resistance (G) [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149065#pone.0149065.ref024" target="_blank">24</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0149065#pone.0149065.ref025" target="_blank">25</a>] and gestational diabetes (B).</p

Thyrotropin (TSH), free thyroxine (fT4) and thyroperoxidase (TPO) antibodies among women with and without gestational diabetes (GDM).

<p>Thyrotropin (TSH), free thyroxine (fT4) and thyroperoxidase (TPO) antibodies among women with and without gestational diabetes (GDM).</p