Lower anti-Müllerian hormone levels are associated with HIV in reproductive age women and shorter leukocyte telomere length among late reproductive age women

Clara E Van Ommen; Anthony Y Y Hsieh; Arianne Y Albert; Elana R Kimmel; Helene C F Cote; Evelyn J Maan; Jerilynn C Prior; Neora Pick; Melanie C M Murray

doi:10.1097/QAD.0000000000003481

Reproductive Endocrinology Ovarian Hormones

Lower anti-Müllerian hormone levels are associated with HIV in reproductive age women and shorter leukocyte telomere length among late reproductive age women

Van Ommen CE, Hsieh AYY, Albert AY, Kimmel ER, Cote HCF, Maan EJ, Prior JC, Pick N, Murray MCM

Published April 2023 AIDS, 37(5), 769-778

DOI 10.1097/QAD.0000000000003481 PMID 36726239 PMC PMC9994852

RRM Academy Synopsis

HIV was associated with 20% lower AMH in women under 35

A cohort study of 462 women aged 12 to 50 found that after adjustment, women under 35 with HIV had 20% lower anti-Müllerian hormone (AMH), a marker of egg supply. In women 35 and older, shorter leukocyte telomere length was associated with lower AMH, and HIV status showed no association.

Key Findings

Across all 462 women, age alone explained a large share of AMH variation (R2 = 0.49). AMH increased until the mid-twenties and declined in the mid-thirties.
Among 259 women under 35 (150 with HIV, 109 controls), HIV was independently associated with 20% lower AMH. Each year of age was associated with a 26% AMH increase.
Among 244 women aged 35 or older (155 with HIV, 80 controls), each unit of relative telomere length was associated with 43% higher odds of the higher AMH category.
In 96 women under 35 followed a median of 2.5 years, HIV was independently associated with faster AMH gain, and current and past smoking with slower gain.
In 88 women aged 35 or older followed a median of 4.6 years, initial AMH was the only variable independently associated with yearly AMH change.

Interpretation

This cohort study followed 462 women aged 12 to 50, measuring AMH and leukocyte telomere length in blood from women with and without HIV. Sensitivity analyses kept the HIV, age and telomere findings stable. The authors call for further study to test whether HIV, immune aging and ovarian reserve are causally related.

RRM Context

AMH is made by cells in developing follicles and serves as a marker of ovarian reserve. In this study its level was associated with age and HIV status in women under 35, and with age, telomere length and current opioid use in women 35 and older. Restorative reproductive medicine takes a root-cause view of such markers: a low result prompts a search for contributing factors across a person's whole health.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objectives

We sought to better understand factors associated with ovarian aging in women with HIV (WWH).

Design

HIV has been associated with diminished fertility, younger age at menopause, and shorter leukocyte telomere length (LTL), a marker of cellular aging. We herein examine cross-sectional and longitudinal associations between LTL, anti-Müllerian hormone (AMH), and HIV.

Methods

We included WWH and HIV-negative women 12-50 years of age in the CARMA cohort with one or more study visit(s). LTL and AMH were measured by qPCR and ELISA, respectively. Women were analyzed in peak reproductive (<35 years) vs. late reproductive (≥35 years) life phases. Using multivariable mixed-effect linear or logistic regressions, we assessed factors associated with AMH and ΔAMH/year while adjusting for relevant confounders.

Results

WWH had shorter LTL and lower AMH levels compared to HIV-negative controls despite being of similar age. After adjusting for relevant factors, HIV was associated with 20% lower AMH levels in women under 35 years of age and shorter LTL was associated with AMH levels below 2 ng/ml among women aged 35 years or older. Longitudinally, ΔAMH/year was largely related to initial AMH level among older women, and to age in younger women.

Conclusions

Factors associated with AMH change across women's reproductive lifespan. Lower AMH among peak reproductive aged WWH suggests that HIV may have an initial detrimental effect on ovarian reserve, an observation that may warrant counseling around pregnancy planning. In women aged 35 years or older, the association between shorter LTL and lower AMH suggests that the immune and reproductive aging connections are more important in this age group.

Topics

Reproductive Endocrinology › Ovarian Hormones › Estrogen · Longevity and Reproductive Aging › Reproductive Aging › Ovarian Aging · Diagnostics › Hormone Testing › Serum Panels

Clara E Van Ommen, Anthony Y Y Hsieh, Arianne Y Albert, Elana R Kimmel, Helene C F Cote, Evelyn J Maan, Jerilynn C Prior, Neora Pick, Melanie C M Murray

C Ommen, Tony Hsieh, A Hsieh, A Albert, E Kimmel, H Cote, E Maan, J Prior, N Pick, M Murray

PMID 36726239 36726239 DOI 10.1097/QAD.0000000000003481 10.1097/QAD.0000000000003481 Van Ommen et al. 2023, Van Ommen 2023

Lower anti-Müllerian hormone levels are associated with HIV in reproductive age women and shorter leukocyte telomere length among late reproductive age women

HIV was associated with 20% lower AMH in women under 35

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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