全球队列中年感染人类免疫缺陷病毒女性生殖衰老转变的相关性和时间：来自 REPRIEVE 试验的见解。
Correlates and Timing of Reproductive Aging Transitions in a Global Cohort of Midlife Women With Human Immunodeficiency Virus: Insights From the REPRIEVE Trial.
机构信息
Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
出版信息
J Infect Dis. 2020 Jul 9;222(Suppl 1):S20-S30. doi: 10.1093/infdis/jiaa214.
BACKGROUND
Reproductive aging may contribute to cardiometabolic comorbid conditions. We integrated data on gynecologic history with levels of an ovarian reserve marker (anti-müllerian hormone [AMH)] to interrogate reproductive aging patterns and associated factors among a subset of cisgender women with human immunodeficiency virus (WWH) enrolled in the REPRIEVE trial.
METHODS
A total of 1449 WWH were classified as premenopausal (n = 482) (menses within 12 months; AMH level ≥20 pg/mL; group 1), premenopausal with reduced ovarian reserve (n = 224) (menses within 12 months; AMH <20 pg/mL; group 2), or postmenopausal (n = 743) (no menses within12 months; AMH <20 pg/mL; group 3). Proportional odds models, adjusted for chronologic age, were used to investigate associations of cardiometabolic and demographic parameters with reproductive aging milestones (AMH <20 pg/mL or >12 months of amenorrhea). Excluding WWH with surgical menopause, age at final menstrual period was summarized for postmenopausal WWH (group 3) and estimated among all WWH (groups 1-3) using an accelerated failure-time model.
RESULTS
Cardiometabolic and demographic parameters associated with advanced reproductive age (controlling for chronologic age) included waist circumference (>88 vs ≤88 cm) (odds ratio [OR], 1.38; 95% confidence interval, 1.06-1.80; P = .02), hemoglobin (≥12 vs <12 g/dL) (2.32; 1.71-3.14; P < .01), and region of residence (sub-Saharan Africa [1.50; 1.07-2.11; P = .02] and Latin America and the Caribbean [1.59; 1.08-2.33; P = .02], as compared with World Health Organization Global Burden of Disease high-income regions). The median age (Q1, Q3) at the final menstrual period was 48 (45, 51) years when described among postmenopausal WWH, and either 49 (46, 52) or 50 (47, 53) years when estimated among all WWH, depending on censoring strategy.
CONCLUSIONS
Among WWH in the REPRIEVE trial, more advanced reproductive age is associated with metabolic dysregulation and region of residence. Additional research on age at menopause among WWH is needed.
CLINICAL TRIALS REGISTRATION
NCT0234429.
背景
生殖衰老可能导致心血管代谢合并症。我们整合了妇科病史和卵巢储备标志物（抗苗勒管激素[AMH]）水平的数据，以探究艾滋病毒（HIV）阳性女性（WHW）中一部分人的生殖衰老模式和相关因素，这些 WHW 参加了 REPRIEVE 试验。
方法
共有 1449 名 WHW 被分为绝经前（n=482）（12 个月内有月经；AMH 水平≥20 pg/mL；第 1 组）、绝经前卵巢储备功能降低（n=224）（12 个月内有月经；AMH<20 pg/mL；第 2 组）或绝经后（n=743）（12 个月内无月经；AMH<20 pg/mL；第 3 组）。采用比例优势模型，调整了年龄，以调查心血管代谢和人口统计学参数与生殖衰老里程碑（AMH<20 pg/mL 或 12 个月以上闭经）之间的关系。排除接受过手术绝经的 WHW 后，使用加速失效时间模型总结绝经后 WHW（第 3 组）的最后一次月经年龄，并在所有 WHW（第 1-3 组）中进行估计。
结果
与年龄相关的心血管代谢和人口统计学参数（控制年龄）包括腰围（>88 与≤88 cm）（比值比[OR]，1.38；95%置信区间，1.06-1.80；P=0.02）、血红蛋白（≥12 与<12 g/dL）（2.32；1.71-3.14；P<0.01）和居住地（撒哈拉以南非洲[1.50；1.07-2.11；P=0.02]和拉丁美洲和加勒比地区[1.59；1.08-2.33；P=0.02]，与世界卫生组织全球疾病负担高收入地区相比）。当描述绝经后 WHW 时，最后一次月经的中位年龄（Q1，Q3）为 48（45，51）岁，当在所有 WHW 中估计时，分别为 49（46，52）或 50（47，53）岁，这取决于截尾策略。
结论
在 REPRIEVE 试验的 WHW 中，更先进的生殖年龄与代谢失调和居住地有关。需要对 WHW 的绝经年龄进行更多的研究。
临床试验注册
NCT0234429。
Zotero 插件