Impact of street drug use, HIV infection, and highly active antiretroviral therapy on reproductive hormones in middle-aged women.
OBJECTIVE
To assess the impact of street drug use and HIV infection on reproductive hormones in 82 women aged 28?56 and 15 HIV-uninfected, regularly cycling premenopausal historical controls.


METHODS
Prospective, pilot cohort study. Baseline blood samples were assayed for follicle stimulating hormone (FSH), human chorionic gonadotropin (hCG), prolactin (PRL), thyroid stimulating hormone (TSH), and estradiol (E(2)). Menopausal status was defined as premenopause: age<40, not amenorrheic; perimenopause: age>40, not amenorrheic; menopause: age>40, with> or =12 months' amenorrhea. Kruskal-Wallis testing was used to compare groups of women sorted by menopausal status and separated by drug use and HIV serostatus. Controls were regularly cycling premenopausal women.


RESULTS
Thirty-eight of the 82 women (46%) reported substance abuse, and 47 of the 82 (57%) were HIV infected. TSH did not differ by HIV serostatus or drug use. PRL was elevated in drug users compared with nonusers and healthy volunteers (10.3, 5.9 vs. 6.2 ng/ml, respectively, p = 0.002), with no effect of HIV serostatus. FSH was reduced in each menstrual category related to drug use and in postmenopausal women associated with positive HIV serostatus. Highly active antiretroviral therapy (HAART) use was not related to PRL or E(2) but was associated with higher FSH. FSH was greater in cohort participants compared with controls.


CONCLUSIONS
Drug use, not HIV, relates to increased PRL. Both drug use and HIV infection are associated with decreased FSH. Women in this socioeconomic stratum at high risk for HIV may be at risk for early menopause. Increased PRL may falsely reduce FSH, necessitating a more careful hormonal characterization of menopausal status in this sample of women.
Santoro
Nanette
N
Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10461, USA. glicktoro@aol.com
Arnsten
Julie H
JH
Buono
Donna
D
Howard
Andrea A
AA
Schoenbaum
Ellie E
EE
D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000097:blood; D015897:Comorbidity; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs; D008875:Middle Aged; D010865:Pilot Projects; D011388:Prolactin / Q000097:blood*; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000097:blood* / Q000453:epidemiology; D013972:Thyrotropin / Q000097:blood*; D014481:United States / Q000453:epidemiology
D019380:Anti-HIV Agents; D006063:Chorionic Gonadotropin; D013287:Illicit Drugs; D004958:Estradiol; D011388:Prolactin; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin