Objective:

To compare white matter disease (WMD) burden between female and male participants with HIV (PWH) from the SEx differences in MechANisms of impaired cogniTIon in the MACS/WIHS Combined Cohort Study (SEMANTICCS).  

Background:

PWH have a high prevalence of cerebral WMD despite viral suppression on antiretroviral therapy (ART). Women with HIV, who are at elevated risk of clinical stroke events, may also be more susceptible to subclinical WMD on MRI.

Design/Methods:

Participants on ART at moderate to high cardiovascular disease (CVD) risk were enrolled at 3 U.S. sites and underwent brain MRI. A radiologist blinded to clinical data assigned Fazekas score based on visual rating of WMD, ranging from 0 (no WMD) to 3 (severe WMD). We constructed linear regression models adjusted for demographics, CVD and other factors to assess the association of sex with log-transformed WMD.

Results:

Among 151 participants, 55% were female, median age was 58 years, and median viral load was <20 copies/mL. The distribution of race/ethnicity differed by sex (57% Black, 17% White, 11% Hispanic female participants vs. 22% Black, 47% White, 18% Hispanic male participants, p<0.001). Female participants were more likely to be current smokers (37% vs 19%, p=0.04), and to have higher BMI (31.8 vs. 28.8 kg/m2, p=0.01) and more depressive symptoms (Center for Epidemiologic Studies Depression Scale score 14 vs 9, p=0.018). No difference was observed in diabetes prevalence or use of anti-hypertensive or cholesterol-lowering medications. Female sex was associated with greater burden of WMD (176%, 95% CI 20%-537%, p=0.017), independent of age, race/ethnicity, CVD and other factors, including those that differed by sex.

Conclusions:

Among PWH, female individuals may have a higher burden of subclinical WMD than male individuals, which is not explained by differences in demographics or CVD risk factors. Research is needed to identify drivers of elevated cerebrovascular risk in women with HIV.