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

Abstract

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).

A prospective study revealing a compounded burden of COVID-19, sex, and clinical diagnosis of alcohol use disorder and HIV infection on quality of life, anxiety, and alcohol use

“…Cognitive impairments identified in members of our clinical sample (AUD, HIV, AUD + HIV) ( Fama et al, 2012 , 2016 ) might have contributed to observed lower QoL. Previous studies also underscored lower cognitive performance in women compared to men in both AUD ( Fama et al, 2020 ; Nixon, 1994 ) and HIV ( Dreyer et al, 2022 ; Rubin et al, 2020 ), which might partially explain the increased vulnerability of women under pandemic conditions.…”

Elevated homocysteine levels may moderate and mediate the association between HIV and cognitive impairment among middle-aged and older adults in an underserved population in Baltimore, Maryland

“…Further studies are needed to examine if, and to what extent, additional factors trigger cognitive decline and influence the association of HIV with NCI. 47 Therefore, there is a need for continued research to better understand the complex interplay between HIV infection and cognitive function, particularly in the ART era.…”

“…Several studies have attempted to examine whether women are more susceptible to HIV-related cognitive dysfunction compared to men. 47 However, these studies have yielded inconsistent findings on the existence, magnitude, and pattern of sex differences. One of the primary reasons for these inconsistencies is the small sample sizes in many of these studies, which can limit statistical power and the ability to detect significant differences between men and women.…”

“…Through meta-analysis, sex differences in cognitive performance among people of HIV have been found to be small. 47 Differences in sociodemographic and psychiatric characteristics between women with HIV and men with HIV varied across studies and contributed to the inconsistencies observed in the findings.…”

Inhibitory Neurotransmission Is Sex-Dependently Affected by Tat Expression in Transgenic Mice and Suppressed by the Fatty Acid Amide Hydrolase Enzyme Inhibitor PF3845 via Cannabinoid Type-1 Receptor Mechanisms

“…The selected upregulation of AEA and related non-eCB lipids specifically in the PFC of Tat(+) females but not male mice is an interesting finding and parallels a previous study that demonstrated upregulated CB 1 R expression levels in female Tat(+) mice which also showed inhibitory control deficits [ 32 ]. In general, HIV literature finds a higher vulnerability of HAND in women [ 112 , 113 , 114 , 115 , 116 ] even though it appears that HIV+ men and women may have different cognitive profiles that are domain specific [ 117 , 118 , 119 ]. Additional studies are needed to clarify the difference in HAND pathology between sexes and the differential role that sex plays on the eCB system in HAND.…”