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 (E₂). Menopausal status was defined as premenopause: age<40, not amenorrheic; perimenopause: age>40, not amenorrheic; menopause: age>40, with≥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 E₂ 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.