This Week in HIV Research: Gendered Nuances in Care and Complications
For this week's exploration of recently published HIV research, we focused on an array of gender-specific findings worth noting. Specifically, our four selections this week suggest that:
- Alcohol use may have a greater detrimental effect on HIV care for women than it does for men.
- Cognitive test performance may be worse among women living with HIV than men living with HIV.
- Cardiovascular risk appears to be higher for HIV-positive trans women than HIV-positive men.
- Glycemic control is unrelated to HIV status for men -- but it does appear to affect cognitive function either way.
We've got additional details on each of these studies just ahead. To beat HIV, you have to follow the science!
Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.
Myles Helfand is the executive editor and general manager of TheBody.com and TheBodyPRO.com. Follow Myles on Twitter: @MylesatTheBody.
Alcohol Use Worsens HIV Care Outcomes, Especially Among Women
Among U.S. veterans, alcohol use is associated with poorer outcomes for women than men throughout the HIV care continuum, a data analysis published in AIDS found.
The 971 women included in the study were less likely to meet targets at each step of the HIV care continuum than the 32,253 men. Overall, 71.9% of women and 77.9% of men were engaged in care; 60.0% and 73.8%, respectively, were on treatment; and 46.4% of women were virally suppressed compared to 55.8% of men. All participants had access to free HIV care. The findings were based on health records data from the Veterans Aging Cohort Study spanning from February 2008 to September 2014.
At higher levels of alcohol use, care continuum outcomes were worse among women than men when compared to non-drinking participants of the same sex. The results may reflect social vulnerabilities that predispose women to alcohol-related risk, as well as metabolic differences that heighten the effect of alcohol on women's health, study authors suggested. They called for targeted interventions to help women living with HIV -- and especially those with other conditions, such as mental health issues -- access and remain in care.
Sex-Based Differences in Cognitive Performance Seen Among People With HIV
Women living with HIV performed worse on cognitive function tests than did men living with the virus, according to a comparison of data from two large U.S. studies. The comparison was published in the Journal of Acquired Immune Deficiency Syndrome.
Half of the 1,420-person study sample, derived from participants in the massive, ongoing Women's Interagency HIV Study and Multicenter AIDS Cohort Study, identified as women. Similarly, the study included 429 women living with HIV as well as 429 men living with the virus. Among those living with HIV, women performed worse on 4 of 5 cognitive function tests, but not on a test that measures the ability to inhibit cognitive interference. This difference by sex was not observed among HIV-negative participants.
Most of those living with HIV were on treatment, and results did not change after controlling for CD4 count and viral load.
Explanations for differences in cognition may include the effects of psychological factors, such as stress and post-traumatic stress disorder, or past substance use, study authors hypothesized. Menopause and different pharmacokinetics of antiretrovirals in women may also play a role, they added. Authors called for longer-term follow-up of the cohort to examine these differences as people age.
Higher Cardiovascular Risk Among Trans Women Compared to Cis Men
Higher rates of anemia and hepatitis C (HCV), as well as poor HIV control, may contribute to a heightened risk of cardiovascular disease among transgender women living with HIV, according to a data analysis described in a letter to the editor of Journal of Acquired Immune Deficiency Syndrome.
Researchers matched 23 transgender women with 92 cisgender men, all of whom were living with HIV and participated in the Partners HIV Cohort study. Trans women were less likely to be in HIV care (68% vs. 83% among cis men), and more likely to be coinfected with HCV (43% vs. 26%), have diabetes (22% vs. 14%) or be anemic (65% vs. 38%). All of these factors have been shown to increase the risk of cardiovascular events among other populations, and most are modifiable.
Study authors hypothesized that the observed rates of anemia may be related to suppression of endogenous testosterone production, which was documented in 30% of transgender women participants. They called for additional research on mechanisms for cardiovascular risk among transgender women living with HIV.
Glycemic Status Related to Cognitive Function, Independent of Serostatus
Among men, glycemic control is related to cognitive functioning regardless of HIV status, a prospective cohort study published in AIDS found. However, impaired fasting glucose and controlled diabetes mellitus were more common among study participants living with HIV (PLWH) compared to those not living with the virus.
A total of 2,049 men, 1,149 of whom live with HIV, completed nine neuropsychological tests for various aspects of cognitive performance semiannually, for a mean of 6.8 years. Glucose levels were also determined at these visits.
Duration of type 2 diabetes mellitus (mean of 7.4 years in PLWH vs. 6.9 years in controls) strongly predicted cognitive performance. CD4 cell nadir -- as a measure of HIV disease stage -- rather than HIV status alone may be a more informative marker in the combination antiretroviral therapy era, study authors suggested.
Given the interplay of aging and cognition, interventions aimed at glycemic control may be more effective in middle age rather than later, study authors noted.