Background:  In the era of HAART, HIV infection is now a chronic disease. But little is known about the effect of HAART or HIV infection itself on ovarian function. Reports of menstrual dysfunction, increased miscarriage rates, and elevated basal follicle-stimulating hormone (FSH) level suggest premature ovarian insufficiency. Our group has previously described an impaired response to ovarian stimulation and a lower pregnancy rate in a series of HIV-infected patients undergoing assisted reproductive techniques. The aim of the current study was to evaluate ovarian function in HIV-infected women aged 18 to 45 in comparison with published data from uninfected women.

Methods:  This is a prospective study using the following markers of ovarian function:  follicle-stimulating hormone (FSH), inhibin B and antimullerian hormone (AMH) for early follicular phase hormonal assessments, and the antral follicular count (AFC) defined by ultrasonography between cycle day 7 and 10. A descriptive analysis according to age was performed.

Results:  A total of 82 patients consented to participate, and results from 78 HIV⁺ women are presented. The mean age was 34.5±0.6 years. The 4 markers are concordant and show an ovarian deficiency with a high rate of abnormal values:  36%, 57%, 23%, and 63% for FSH, inhibin B, AMH, and AFC, respectively. In 85% of the patients, at least 1 marker was abnormal. There was no effect of the treatment status on ovarian markers. No obvious difference in any ovarian markers between disease categories according to CD4 counts and viral load was noted.

Conclusions:  In our series, HIV infection was associated with stigmas of premature ovarian insufficiency based on changes in 4 different ovarian function markers, with no apparent deleterious effect of ART. This may explain impaired fertility, but also premature menopause, in this population who should therefore be monitored early for such changes.