# The Association of Antiretroviral Treatment and Early Menopause in Women Aging with HIV

> **NIH AHRQ R36** · UNIVERSITY OF MARYLAND BALTIMORE · 2020 · $43,070

## Abstract

Women aging with Human Immunodeficiency Virus (HIV) are nearly five times more likely than women
without HIV to experience early menopause (i.e., before age 45). It is unclear why women living with HIV (WLWH)
undergo early menopause, but it is known that these women have irregular menstrual cycles and several periods
of prolonged amenorrhea. Previous studies used self-reported prolonged amenorrhea for at least 12 months to
define menopause. This may have misclassified menopausal status because these studies did not consider
whether women resumed menses after prolonged amenorrhea, nor did they use an objective biomarker to
confirm menopause. Antimullerian hormone (AMH) is the most objective and reliable biomarker of menopausal
transition, and thus can be used to confirm age of menopause among WLWH. An AMH level <0.08 ng/ml is
recognized as undetectable and shown among WLWH to be predictive of menopause approximately 3-5 years
before final menstrual period.
 Research suggests that viral load and CD4+ count may be related to the early menopause, but there is
less definitive research on the role of antiretroviral therapy (ART). There is a clinical and public health need to
identify when WLWH are transitioning to menopause in order to distinguish whether ART is associated with
early menopause. The specific aims are to: confirm age at menopause (Aim 1); determine if WLWH are more
likely than uninfected women to experience menopause earlier (Aim 2); and evaluate the association between
ART use with early menopause among WLWH (Aim 3). The research strategy is to use the National Institutes
of Health’s Women Interagency HIV Study (WIHS), a nationwide, multi-center, ongoing prospective cohort of
WLWH and at-risk, uninfected women. WIHS began enrollment in 1993 (n=4,982), and data collected every six
months include an in-depth interview, physical exam, and specimen collection. This data contain AMH
measurements and has a long follow-up to observe menopausal transition.
 The expected clinical impact of this dissertation research is the advancement of scientific evidence of long-
term health outcomes of WLWH as it pertains to transitioning into menopause. This dissertation addresses the
Agency for Healthcare Research and Quality (AHRQ)’s priority populations by targeting women aging with HIV,
particularly racial/ethnic minorities, the majority of the WIHS cohort. This research also addresses AHRQ’s
research priority areas to improve safety by identifying the potential effects of ART use on early menopause,
which can place women at risk for chronic medical conditions earlier than normal.

## Key facts

- **NIH application ID:** 9985492
- **Project number:** 1R36HS027523-01
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Laura Marie Bozzi
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $43,070
- **Award type:** 1
- **Project period:** 2020-03-15 → 2021-07-02

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9985492

## Citation

> US National Institutes of Health, RePORTER application 9985492, The Association of Antiretroviral Treatment and Early Menopause in Women Aging with HIV (1R36HS027523-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9985492. Licensed CC0.

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