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Cognitive function in women with HIV: findings from the Women's Interagency HIV Study
Pauline M Maki1, Leah H Rubin2, Victor Valcour2
1From the Departments of Psychiatry (P.M.M., L.H.R.) and Psychology (P.M.M.), University of Illinois at Chicago; the Department of Neurology (V.V.), University of California, San Francisco; the Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; the Department of Neurology (H.C.), SUNY Downstate Medical Center, New York, NY; Georgetown University School of Medicine (M.Y.), Washington, DC; The Core Center (K.M.W.), Bureau of Health Services of Cook County, Chicago, IL; the Department of Neurology (J.M.), Columbia University Medical Center, New York, NY; the Department of Preventative Medicine (J.R.), University of Southern California, Los Angeles; the Department of Epidemiology (C.A.), Johns Hopkins University School of Public Health, Baltimore, MD; and the Departments of Medicine and Epidemiology & Population Health (K.A.), Albert Einstein College of Medicine, New York, NY. pmaki@psych.uic.edu.
Objective:
In the largest cohort study of neuropsychological outcomes among HIV-infected women to date, we examined the association between HIV status and cognition in relation to other determinants of cognitive function (aim 1) and the pattern and magnitude of impairment across cognitive outcomes (aim 2).
Methods:
From 2009 to 2011, 1,521 (1,019 HIV-infected) participants from the Women's Interagency HIV Study (WIHS) completed a comprehensive neuropsychological test battery. We used multivariable regression on raw test scores for the first aim and normative regression-based analyses (t scores) for the second aim. The design was cross-sectional.
Results:
The effect sizes for HIV status on cognition were very small, accounting for only 0.05 to 0.09 SD units. The effect of HIV status was smaller than that of years of education, age, race, income, and reading level. In adjusted analyses, HIV-infected women performed worse than uninfected women on verbal learning, delayed recall and recognition, and psychomotor speed and attention. The largest deficit was observed in delayed memory. The association of low reading level with cognition was greater in HIV-infected compared to HIV-uninfected women. HIV biomarkers (CD4 count, history of AIDS-defining illness, viral load) were associated with cognitive dysfunction.
Conclusions:
The effect of HIV on cognition in women is very small except among women with low reading level or HIV-related comorbidities. Direct comparisons of rates of impairment in well-matched groups of HIV-infected men and women are needed to evaluate possible sex differences in cognition.