title: HIV infection, drug use, and onset of natural menopause.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA. eschoenb@montefiore.org
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
authors.forename: Diana
authors.initials: D
authors.lastname: Hartel
authors.forename: Yungtai
authors.initials: Y
authors.lastname: Lo
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Michelle
authors.initials: M
authors.lastname: Floris-Moore
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
authors.forename: Nanette
authors.initials: N
authors.lastname: Santoro
mesh_terms: D000328:Adult; D000375:Aging; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019966:Substance-Related Disorders / Q000378:metabolism*
chemical_list: D019380:Anti-HIV Agents