CD4 and HIV infectious disease: Part of the challenge is that existing studies have not adequately distinguished the unique contribution, if any, of HIV infection or its consequences such as lower CD4 cell count [16, 18], from the contribution of other risk factors for early menopause irregular menses [15], such as drug use [18], tobacco smoking [67], black/African American race [18], fewer years of education [16, 57], and lower body mass index (BMI) [54, 59], all of which are common among persons living with HIV infection.