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. 2015 Jun;212(6):765.e1-765.e13.
doi: 10.1016/j.ajog.2014.12.040. Epub 2014 Dec 31.

Predictors of early menopause in HIV-infected women: a prospective cohort study

Guilherme Amaral Calvet  1 , Beatriz Gilda Jegerhorn Grinsztejn  2 , Marcel de Souza Borges Quintana  2 , Monica Derrico  2 , Emilia Moreira Jalil  2 , Andrea Cytryn  2 , Angela Cristina Vasconcelos de Andrade  2 , Ronaldo Ismerio Moreira  2 , Marcelo Ribeiro Alves  2 , Valdiléa Gonçalves Veloso Dos Santos  2 , Ruth Khalili Friedman  2
Affiliations

Predictors of early menopause in HIV-infected women: a prospective cohort study

Guilherme Amaral Calvet et al. Am J Obstet Gynecol. 2015 Jun.

Abstract

Objective: This study sought to investigate the age at natural menopause and its predictors in a cohort of human immunodeficiency virus (HIV)-infected women in Rio de Janeiro, Brazil.

Study design: HIV-infected women ≥30 years of age were included. Menopause was defined as having ≥1 year since the last menstrual period. Early age at natural menopause was defined as the onset of menopause at ≤45 years of age. Multivariate Cox proportional hazards analysis was applied.

Results: A total of 667 women were included, and the median age at baseline was 34.9 years (interquartile range, 30.9-40.5 years). In all, 507 (76%) women were premenopausal, and 160 (24%) reached menopause during the observational period; of these, 36 of 160 (27%) had early menopause. The median age at natural menopause was 48 years (interquartile range, 45-50 years). Menarche at <11 years of age (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.23-3.37), cigarette smoking during the observational period (HR, 1.59; 95% CI, 1.08-2.33), chronic hepatitis C virus (HCV) infection (HR, 2.53; 95% CI, 1.27-5.07), and CD4 count <50 cells/mm(3) (HR, 3.07; 95% CI, 1.07-8.80) were significantly associated with an earlier age at natural menopause. The magnitudes of the effects of menarche at <11 years of age (HR, 2.7; 95% CI, 1.23-5.94), cigarette smoking during the observational period (HR, 3.00; 95% CI, 1.39-6.45), chronic HCV infection (HR, 6.26; 95% CI, 2.12-18.52), and CD4 count <50 cells/mm(3) (HR, 6.64; 95% CI, 1.91-23.20) were much higher and significantly associated with early natural menopause.

Conclusion: Early natural menopause was frequent among the HIV-infected women. In addition to menarche and cigarette smoking, which are menopausal factors among women in general, HIV-related immunodeficiency and chronic HCV were additional predictors for an earlier age at natural menopause. Adequate management of HIV in women is critical, as early onset of menopause has been associated with increased morbidity and mortality.

Keywords: chronic hepatitis C; cohort studies; early menopause; human immunodeficiency virus; menopause.

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