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Absence of Polycystic Ovary Syndrome Features in Human Immunodeficiency Virus-Infected Women Despite Significant Hyperinsulinemia and Truncal Adiposity

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

Address all correspondence and requests for reprints to: Steven Grinspoon, M.D., Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts 02114. E-mail: sgrinspoon{at}partners.org.

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 µIU/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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