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Odds of Cognitive Impairment in Women vs Men With HIV


Findings from the largest study to evaluate sex differences in HIV-related cognitive dysfunction.

Women with HIV have higher odds of cognitive impairment than men with HIV, according to a study published in the Journal of Acquired Immune Deficiency Syndromes.1 The study is the largest to date to evaluate sex differences in HIV-related cognitive dysfunction.

“[O]ur results show that cognitive findings from HIV-positive men cannot be uncritically generalized to HIV-positive women and that instead sex should be considered in studies of the pathogenesis, clinical presentation, and treatment of cognitive dysfunction in HIV,” wrote first author Pauline Maki, PhD, of the University of Illinois at Chicago College of Medicine, and colleagues with the Multicenter AIDS Cohort Study.

Cognitive impairment may develop in up to 50% of people living with HIV, and about 25% of people with HIV infection are women. Factors such as poverty, life stressors, trauma, and hormonal and/or biological differences in HIV pathogenesis and antiretroviral metabolism may put women with HIV infection at higher risk for cognitive impairment than men.

Yet most studies of HIV-related cognitive impairment have been conducted in men. The few that have included women have not made direct comparisons of sex differences in cognition.

To bridge this gap, researchers used data from the two longest running longitudinal studies of HIV progression in the US: the Women’s Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). Their study included 710 women (429 HIV positive) and 710 men (429 HIV positive), matched by HIV status, sex, age, education, and black race.

Follow-up occurred for about 2.5 years, with an average of 2.6 cognitive assessments per participant. The analysis adjusted for age, alcohol/drug use, smoking, depression, income, and factors related to HIV.

Key results
• 2.5 higher odds for women vs men of scoring in the impaired range for attention (odds ratio [OR] = 2.54; P = .0006)

• 5 times higher odds for women vs men of scoring in the impaired range for psychomotor speed (OR = 5.12; P < .0001)

• Significantly lower scores for women vs men on attention (P < .0001), executive functioning (P = .01), cognition related to daily tasks (P = .02), and psychomotor speed (P < .0001 - .0002)

• No sex difference for HIV-negative participants

The WIHS and MACS trials are ongoing, with plans to evaluate biological differences and other factors that may affect cognition in HIV-positive women vs HIV-positive men, as well as sex differences in HIV-related cognitive impairment with advancing age.

While non-Hispanic blacks comprised 67% of participants, about 40% of individuals living with HIV in the US are non-Hispanic black, so the results may not generalize more broadly.

Please click below for the take-home points and reference.

Take-home points
• Largest cohort study of sex differences in HIV-related cognitive impairment found HIV-positive women had 2.5 higher odds of impaired attention and 5 times higher odds of impaired psychomotor speed compared with HIV-positive men.

• HIV-positive women also showed significant impairments in executive function and cognition related to daily tasks compared with HIV-positive men.

• Ongoing studies plan to evaluate biological differences and age-related changes that may differentially affect cognition in HIV-positive women vs HIV-positive men.


1. Maki PM, Rubin LH, Springer G, et al. Differences in cognitive function between women and men with HIV. J Acquir Immune Defic Syndr. 2018 May 25. doi: 10.1097/QAI.0000000000001764.

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