Table 5.

Summary of Studies Reporting Sex Differences for Neurocognitive Impairment Among People With HIV

Author, Year [Ref]	Study Design Study Size (% PWH) No. of Men and Women	Study Population (Location, Race/Ethnicity, Age)	Outcomes Measured	Key Findings	Limitations
Burlacu et al, 2018 [97]	Cross-sectional N = 322 (78% PWH) 162 men, 160 women	•\tChildren with perinatally acquired HIV in Bucharest, Romania •\tRace/ethnicity data not available •\tMean age: 23 y	Global neurocognition and domain scores (verbal fluency, working memory, processing speed, learning and memory, executive function, and motor function)	•\tWWH scored lower than MWH in working memory domain (P<.05) •\tWWH scored lower than women without HIV in motor domain (P<.05) •\tHIV significantly modified the effect of sex in the motor domain (P<.05)	WWH had less advanced HIV disease than MWH. Did not capture menopause status.
Sundermann et al, 2018 [98]	Cross-sectional N = 2063 (66% PWH) 1645 men, 418 women	•\tAdults enrolled in UCSD HIV Neuro-behavioral Research Program •\t25% Black, 56% White, 14% Hispanic, 2% Asian •\tMean age: 42 y	Global neurocognitive deficit and domain deficit scores (verbal fluency, working memory, processing speed, verbal and visual learning and delayed recall, executive function, and motor function)	•\tCompared with women and men without HIV, the odds of NCI was higher among WWH (OR, 2.90 [95% CI, 1.93–4.35]) and MWH (OR, 1.95 [95% CI, 1.54–2.47]), respectively •\tOdds of NCI associated with HIV were attenuated after adjusting for reading level among women (aOR, 2.33 [95% CI, 1.52–3.57], P<.05) but not men	Women were underrepresented. Did not capture menopause status.
Maki et al, 2018 [99]	Longitudinal cohort N = 1420 (60% PWH) 710 men, 710 women	•\tAdults enrolled in the MACS/WIHS Combined Cohort Study •\t67% African American, 11% White, 20% Hispanic •\tMean age: 41 y	Performance on 5 neurocognitive tests (TMTA, TMTB, SDMT, Stroop, and GP)	•\tWWH scored significantly worse than MWH on TMTA, TMTB, SDMT, GP dominant, and GP nondominant •\tWWH vs MWH had higher odds of scoring in the impaired range on TMTA (OR, 2.54, P<.05) and GP nondominant (OR, 5.12, P<.05); these differences persisted after adjusting for HIV-related characteristics	Did not compare verbal learning and memory domains. Did not control for mental health factors other than depression. Did not capture menopause status.
Royal et al, 2016 [100]	Cross-sectional N = 207 (72% PWH) 77 men, 130 women	•\tPWH cared for at 2 HIV centers in Abuja, Nigeria (National Hospital and the University of Abuja Teaching Hospital) •\tRace/ethnicity data not available •\tMean age: 30 y (people without HIV), 34 y (PWH)	Global neurocognitive deficit and domain deficit scores (verbal fluency and category fluency, working memory, processing speed, learning and memory, executive function, and motor function)	•\tWWH compared with women without HIV had greater impairment in processing speed (28% vs 5%, P<.05) •\tWWH vs MWH had greater impairment in learning (27% vs 7%, P<.05) and memory (26% vs 9%, P<.05) domains •\tSex significantly modified the effect of HIV on performance in processing speed, learning, and memory domains	Small sample sizes. Unbalanced HIV status and sex groups. Did not capture menopause status.
Kabuba et al, 2016 [102]	Cross-sectional N = 266 (100% PWH) 107 men, 159 women	•\tPWH cared for at 6 urban clinics in Lusaka, Zambia •\tMean age: 41 y	Global neurocognitive deficit and domain deficit scores (verbal fluency, working memory, processing speed, learning, delayed recall, executive function, and motor function)	•\tNo significant differences between MWH and WWH in any demographic-adjusted domain score or global score •\tAfter adjusting for HIV characteristics, WWH performed worse than MWH in the delayed recall domain (mean T-score: 43.68 vs 47.99, P<.05)	Did not include persons without HIV for comparison (although normative data from 324 persons without HIV for comparison). Did not capture menopause status.

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; GP, grooved pegboard; MACS/WIHS, Multicenter AIDS Cohort Study/Women’s Interagency HIV Study; MWH, men with HIV; NCI, neurocognitive impairment; OR, odds ratio; PWH, people with HIV; SDMT, Symbol Digit Modalities Test; TMTA, Trail Making Test A; TMTB, Trail Making Test B; UCSD, University of California, San Diego; WWH, women with HIV.