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Sex Differences in the Patterns and Predictors of Cognitive Function in HIV
Leah H Rubin1,2,3, Erin E Sundermann4, Raha Dastgheyb1
1Department of Neurology, Johns Hopkins University, Baltimore, MD, United States.
Frontiers in Neurology
|December 17, 2020
Summary
Cognitive impairment in people with HIV (PWH) varies by sex. Machine learning identified distinct cognitive profiles in women with HIV (WWH) and men with HIV (MWH), revealing sex-specific patterns and shared risk factors.
Area of Science:
- Neuroscience
- Psychology
- Immunology
Background:
- Antiretroviral therapy has improved outcomes for people with HIV (PWH), yet mild cognitive deficits persist in nearly half.
- Cognitive impairment in PWH is variable, affecting diverse domains, with some evidence suggesting greater impairment in women with HIV (WWH) compared to men with HIV (MWH).
- Understanding sex-specific differences in cognitive impairment profiles and associated risk factors among PWH is crucial for targeted interventions.
Purpose of the Study:
- To identify distinct cognitive functioning profiles in a large sample of PWH using machine learning.
- To investigate how sociodemographic, clinical, and biological factors are associated with these cognitive profiles, overall and stratified by sex.
- To elucidate sex differences in cognitive impairment patterns and their risk factors in people living with HIV.
Main Methods:
- Utilized machine learning (Kohonen self-organizing maps) on neuropsychological test data from 1,666 PWH (201 WWH, 1,465 MWH).
- Employed random forest models to identify factors associated with cognitive profiles, including sociodemographic, clinical, and biological variables.
- Analyses were conducted overall and repeated within each sex to identify sex-specific patterns.
Main Results:
- Three cognitive profiles were identified overall and within each sex.
- Men with HIV (MWH) showed unimpaired, global weakness, and attention/processing speed strength profiles.
- Women with HIV (WWH) did not have an unimpaired profile, instead showing profiles with motor skill weakness, learning/recall deficits, or global weakness with spared recognition.
- Key discriminative factors, including reading level, CD4 count, viral load, HIV duration, age, depressive symptoms, and race/ethnicity, were similar between sexes.
Conclusions:
- Significant sex differences exist in cognitive impairment profiles among people with HIV (PWH).
- Women with HIV (WWH) exhibit more pervasive cognitive challenges compared to men with HIV (MWH).
- Identified cognitive profiles and associated factors can inform personalized risk reduction and therapeutic strategies for cognitive dysfunction in PWH.
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