J Clin Endocrinol Metab. 2005 Aug 2
Absence of PCOS Features in HIV-infected Women Despite Significant Hyperinsulinemia and Truncal Adiposity.
Johnsen S, Dolan SE, Fitch K, Killilea K, Shifren JL, Grinspoon SK.
Program in Nutrition and Metabolism (S.J., K.K., S.D., S.G) and Vincent Memorial Obstetrics and Gynecology Service (J.S.), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114.
Context: HIV-infected women increasingly demonstrate insulin resistance and fat redistribution characterized by relative truncal adiposity. It is unknown if insulin resistance and truncal adiposity are associated with features of the polycystic ovary syndrome (PCOS) in this population.
Objective: To characterize ovarian morphology and reproductive indices in a large cohort of HIV-infected women in comparison to healthy age and BMI-matched control subjects. Setting: Academic medical center Subjects: 88 HIV-infected women were compared with 94 age and BMI-matched healthy control subjects. Main Outcome Measures: Androgen, SHBG, and gonadotropin levels and ovarian morphology. Results: HIV infected subjects demonstrated increased visceral adipose tissue (VAT) (101 +/- 6 vs. 71 +/- 5 cm(2), P < 0.0001), increased VAT: SAT and a trend toward decreased abdominal sc adipose tissue (SAT). Fasting insulin (12 +/- 1 vs. 6 +/- 1 microIU/mL, P < 0.001) and 2-hour 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/L, 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: FSH (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.
Conclusion: These data demonstrate that among HIV-infected subjects with severe abdominal fat accumulation and hyperinsulinemia, common features of PCOS are not seen.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16076939&query_hl=7 
Absence of PCOS Features in HIV-infected Women Despite Significant Hyperinsulinemia 
