Cognitive Performance in Men and Women Infected with HIV-1

Cognitive Differences between Men and Women with HIV: A Systematic Review and Meta-Analysis

OBJECTIVE

Although many studies report that women with HIV (WWH) are more vulnerable to cognitive impairment than men with HIV (MWH), this trend is not described consistently in the literature. In this systematic review and meta-analysis, we investigated whether the weight of evidence supports the existence of a significant sex difference in cognitive functioning among people with HIV and, if so, whether specific domains are affected.

METHOD

A systematic literature search retrieved 4,062 unique articles published between January 2000 and June 2019. Eligibility criteria were that studies directly compared adult WWH and MWH using a neuropsychological test battery. After extensive screening, we included 11 studies in the systematic review (N = 3,333) and 6 in the meta-analysis (N = 2,852).

RESULTS

Six studies included in the systematic review found WWH performed significantly more poorly on measures of cognitive performance than MWH; the other five found no sex differences. Meta-analytic results indicated that WWH performed significantly more poorly than MWH in three cognitive domains (psychomotor coordination, visuospatial learning, and memory), but magnitudes of effect sizes were small (d = -.16, -.43, and - .30, respectively). Analyses detected no sex differences in global cognitive functioning and in the other cognitive domains.

CONCLUSIONS

Sex differences in cognitive performance are small, and sociodemographic and psychiatric characteristics of WWH and MWH differ between studies. Cognitive differences between WWH and MWH may be explained by sex-based variation in these characteristics, the impact of which seems to outweigh that of HIV-related clinical variables (e.g., CD4 count and viral load).

Relationship between High Sensitivity-C Reactive Protein Level and Impaired Cognitive Function in HIV Patients

Human Immunodeficiency Virus (HIV) infection was one of the most serious health challenges in the world. The Ministry of Health of the Republic of Indonesia reports the number of HIV cases in Indonesia as of June 2019 as many as 349,882. At present, although antiretroviral combination therapy has been found, the prevalence of neurocognitive disorders in the form of HIV-associated neurocognitive disorders (HAND) reaches 50% of HIV patients. This study aimed to determine the relationship between high sensitivity-C Reactive Protein (hs-CRP) level and cognitive impairment assessed using MoCA-INA score in HIV patients at the UPIPI Dr. Soetomo Academic Hospital Surabaya. This cross-sectional study used consecutive sampling that fulfilled inclusion and exclusion criteria. The cognitive function of the subjects was examined by MoCA-INA score and blood samples were collected for measuring hs-CRP level. Of 100 subjects, 41 had abnormal MoCA-INA score and 59 had normal score. The number of subjects with high level of hs-CRP (>= 5) who had abnormal and normal MoCA-INA score were 22 (53,7%) and 6 (10,2%) respectively. This result was significantly difference with p = 0,0001, RO = 28,072 (95% CI, 5,470-144,052). Therefore, there was a significant relationship between hs-CRP level and cognitive function, where a subject with a high hs-CRP level was more likely to have impaired cognitive function.

HIV- and AIDS-associated neurocognitive functioning in Zambia - a perspective based on differences between the genders

Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) are frequently associated with neurocognitive impairment (NCI). However, few studies have examined the interrelationship between gender and NCI in the HIV and AIDS population. This cross-sectional study examined the neurocognitive (NC) functioning of HIV-infected male and female adults from urban Zambia. The participants included 266 HIV seropositive (HIV+) adults (males [n=107] and females [n=159]). Participants completed NC assessment by means of a comprehensive test battery using normative data from 324 HIV-seronegative (HIV-) controls. The norms corrected for effects of age, education, and gender in the general population, and the test battery measures domains of attention/working memory (learning and delayed recall), executive function, verbal fluency, processing speed, verbal and visual episodic memory, and fine motor skills. An overall comparison of the HIV+ male and female participants yielded no statistically significant differences. Analysis of covariance results controlling for disease characteristics showed that HIV+ female participants had worse delayed recall scores than males, F(1,117) =9.70, P=0.002, partial η(2)=0.077. The females also evidenced a trend toward greater impairment on learning efficiency (P=0.015). The findings suggest that there are gender-related differences in NCI after controlling for disease characteristics. It was observed that although the HIV+ females enjoyed better health compared to their HIV+ male counterparts, they still had worse performance on the neuropsychological tests. This implies that HIV may have more NC consequences for Zambian females than males.

Primary care of women aging with HIV

Women are living longer with HIV infection, but their life expectancy remains shorter than for women in the general population. How best to manage the multiple comorbidities and polypharmacy that are common in individuals wtih HIV has not been studied. This article explores areas where the primary care of women with HIV may differ from that of aging women in the general population. We also discuss aspects of care that may not commonly be considered in those under the age of 65, specifically multimorbidity and polypharmacy. Incorporating a gerontologic approach in the care of these women may optimize outcomes until research provides more definitive answers for how best to collaborate with women with HIV in order to provide them with optimal care.