Difference in the neurocognitive functions of WLWH and MLWH in an Italian cohort of people living with HIV

Based on the available literature, women living with HIV (WLWH) seem to show greater cognitive and emotional disadvantages\r\nthan men living with HIV (MLWH). Our aim was to compare the cognitive performance of MLWH and WLWH\r\nin an Italian cohort of People Living With HIV (PLWH) and to analyse factors potentially contributing to sex differences in\r\ncognitive function. We ran a retrospective, cross-sectional analysis of a monocentric dataset of PLWH who were administered\r\na standardized neuropsychological test battery (SNB) during routine clinical care. We enrolled 161 Italian PLWH who are\r\non combined antiretroviral therapy (cART): 114 (70.8%) MLWH and 47 (29.2%) WLWH.\r\nGlobal cognitive performance (composite z score) (GCP) was significantly higher in MLWH than WLWH [mean 0.19 (SD\r\n0.85) vs − 0.13 (SD 0.96); p = 0.039]. Moreover, WLWH obtained significantly higher scores on the Zung Depression Scale\r\nthan MLWH [mean 41.8 (SD 10.9) vs 36.7 (SD 9.2); p = 0.003]. However, there was no statistically significant direct effect\r\nbetween male sex and better GCP (p = 0.692) in the context of a mediation model. On the contrary, the associations between\r\nmale sex and better GCP were mediated by higher level of education (a*b = + 0.15, Bootstrap CI95 = 0.05 and 0.27) and a\r\nlower Zung depression score (a*b = + 0.10, Bootstrap CI95 = 0.02 and 0.21).\r\nIn conclusion, the global cognitive performance of WLWH is lower than that of MLWH. However, other demographic and\r\nclinical factors besides sex might help explain differences in their neurocognitive functions and make it possible for us to\r\nmonitor them and identify those patients most in need.