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HIV-infected women may have hyperinsulinemia, truncal adiposity without PCOS
By Will Boggs, MD
NEW YORK (Reuters Health) - Certain features of polycystic ovary (PCO) syndrome seem to be absent in HIV-positive women with hyperinsulinemia and truncal adiposity, according to a report in the October issue of The Journal of Clinical Endocrinology & Metabolism.
"HIV patients may be spared the clinical stigmata of PCO, e.g., lack of increased ovarian follicle number and hirsutism, often associated with the PCO phenotype," Dr. Steven K. Grinspoon from Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts told Reuters Health.
"It is unclear yet whether such patients are therefore protected from cardiovascular disease or other implications of PCO, such as altered menses," he added.
Dr. Grinspoon and associates characterized ovarian morphology and reproductive indices in 88 HIV-infected women and 94 healthy age- and BMI-matched control subjects.
Fasting and 2-hour insulin levels after glucose tolerance testing were significantly higher in HIV-infected women than in control women, the authors report, and impaired glucose tolerance was more than twice as common in HIV-infected women.
Abdominal visceral fat area was significantly higher among HIV-infected women compared with controls, the report indicates, but the two groups did not differ in the rates of oligomenorrhea, amenorrhea, or hirsutism.
Ovarian volume and number of follicles did not differ between HIV-infected women and controls, the researchers note, and the percentage of women with polycystic ovarian morphology was almost identical in the two groups.
"This study suggests that despite severe abdominal fat accumulation and hyperinsulinemia, increased ovarian follicle number, irregular menses, hirsutism, and increased LH to FSH ratio are not seen among HIV-infected women," the authors conclude.
"This paper suggests that both insulin resistance and hyperandrogenemia may be necessary for the development of PCO in women and that hyperinsulinism alone is insufficient for the development of increased ovarian follicles and hirsutism," Dr. Grinspoon said. "Further studies of the cardiovascular consequences of hyperinsulinism in the HIV population are needed."
"We plan to look at the mechanism by which PCO features are absent and further characterize the phenotype in HIV-infected women, looking at measures of endothelial function and atherosclerotic disease, namely carotid intima media thickness," Dr. Grinspoon added.
J Clin Endocrinol Metab 2005;90:5596-5604.
Absence of Polycystic Ovary Syndrome Features in Human Immunodeficiency Virus-Infected Women Despite Significant Hyperinsulinemia and Truncal Adiposity
Stine Johnsen, Sara E. Dolan, Kathleen V. Fitch, Kathleen M. Killilea, Jan L. Shifren and Steven K. Grinspoon
Program in Nutritional and Metabolism (S.J., S.E.D., K.V.F., K.M.K., S.K.G.) and Vincent Memorial Obstetrics and Gynecology Service (J.L.S.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
Context: HIV-infected women increasingly demonstrate insulin resistance and fat redistribution characterized by relative truncal adiposity. It is unknown whether insulin resistance and truncal adiposity are associated with features of the polycystic ovary syndrome in this population.
Objective: The objective of the study was to characterize ovarian morphology and reproductive indices in a large cohort of HIV-infected women in comparison with healthy age- and body mass index-matched control subjects.
Setting: The study was conducted at an academic medical center.
Subjects: Eighty-eight HIV-infected women were compared with 94 age- and body mass index-matched healthy control subjects.
Main Outcome Measures: Androgen, SHBG, and gonadotropin levels and ovarian morphology were measured.
Results: HIV-infected subjects demonstrated increased visceral adipose tissue (VAT) (101 ± 6 vs. 71 ± 5 cm2; P < 0.0001), increased VAT to sc adipose tissue ratio, and a trend toward decreased abdominal sc adipose tissue. Fasting insulin (12 ± 1 vs. 6 ± 1 ÁIU/ml; P < 0.001) and 2-h glucose (124 ± 4 vs. 106 ± 4 mg/dl; P = 0.001) were also significantly increased in the HIV-infected women, compared with control subjects, respectively. Despite significant hyperinsulinemia and visceral adiposity, HIV-infected women did not demonstrate irregular menses or an increased number of small ovarian follicles (8.0 ± 0.9 vs. 8.5 ± 0.7 follicles; P = 0.65, HIV-infected vs. controls). Rather, SHBG (124 ± 10 vs. 84 ± 4 nmol/liter; P < 0.001) was increased significantly in HIV-infected women, and free testosterone by equilibrium dialysis was significantly reduced (2.2 ± 0.2 vs. 2.7 ± 0.2 pg/ml; P = 0.04), as was LH to FSH ratio (0.62 ± 0.05 vs. 0.83 ± 0.07; P = 0.03). Menstrual function, androgen levels, and ovarian morphology by ultrasonography were not different between HIV-infected women and healthy controls.
Conclusions: These data demonstrate that among HIV-infected subjects with severe abdominal fat accumulation and hyperinsulinemia, common features of polycystic ovary syndrome are not seen.
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