HIV INFECTION AND INJECTION DRUG USE:

The Importance of Gender

1Amy B. Wisniewski, Ph.D.2Adrian S. Dobs, M.D., MPH

Departments of Pediatrics1 and Medicine2

OBJECTIVES

• To determine the impact of gender on depression, quality of life (QOL) and cognition in HIV infected, injection drug using populations

IMPORTANCE

• By considering gender in the natural history of HIV and IDU, personalized treatments can be developed to optimize outcome

BACKGROUND

• Most studies that describe mental health and cognition in HIV/AIDS and IDU have focused solely on men

• The National Academy of Sciences recommends that health research include men and women

• Researchers should analyze their data for sex differences

• Depression, poor QOL and cognitive impairment are known consequences of HIV/AIDS

• Women, in general, report more depressive symptoms than men

STUDY DESIGNMen and Women

matched by• Age

• Race

• Education

• SES

• IDU

Outcome Measures• Depression– CESD

• QOL–MOS-HIV

• Cognition– Verbal memory– Perceptual speed

PARTICIPANTS

Gender Male

N (%)

31 (51)

Female 30 (49)

HIV status HIV+ 27 (44)

HIV- 34 (56)

IDU status IDU+ 31 (50)

IDU- 30 (49)

Education > 12th grade 40 (66)

< 12th grade 21 (34)

PARTICIPANTS

Males FemalesHIV-IDU- 9 8

HIV+IDU- 9 6

HIV-IDU+ 5 10

HIV+IDU+ 8 6

RESULTS

More women than men reported depression (CESD > 16)

0

5

10

15

20

25

30

35

40

45

50

Mea

n C

ES

D S

core

s

Men Women*

p < .05

Women who were both HIV+ and IDU+ were the most likely to report

depression (CESD > 16)

0

5

10

15

20

25

30

35

40

45

50

CE

SD

Sco

res

HIV-IDU- HIV-IDU+ HIV+IDU- HIV+IDU+*

Women were more likely to show poor (lower) QOL/physical health scores than

men, when adjusted for HIV and IDU.

0

10

20

30

40

50

60

Women Men

Me

an

(S

EM

) M

OS

HIV

Ph

ys

ica

l He

alt

h

Fa

cto

r S

co

re

p < .05

HIV+ participants were more likely to show poor (lower) QOL/physical health

scores than HIV- participants.

0

10

20

30

40

50

60

HIV- HIV+Mea

n (

SE

M)

MO

SH

IV P

hys

ical

Hea

lth

F

acto

r S

core

p < .05

0

10

20

30

40

50

60

HIV- HIV+Mea

n (

SE

M)

MO

SH

IV M

enta

l H

ealt

h

Fac

tor

Sco

re

p < .05

HIV+ participants were more likely to show poor (lower) QOL/mental health

scores than HIV- participants.

COGNITIVE SCORES

• In general, women outperform men on tests of verbal memory

• In general, HIV- outperform HIV+ participants on measures of perceptual speed

HIV STATUS AND GENDER

INTERACT HIV- women perform best, and HIV+ men perform the worst on a test of delayed verbal memory

(p < .05).0

10

20

30

40

50

60

70

80

90

Female (-) Female (+) Male (-) Male (+)

SUMMARY

• Females are at greater risk of depression than males

• This sex difference in depression is most pronounced in females who are both HIV+ and IDU+

• Women and HIV+ participants were most likely to report poor QOL scores

• HIV+ men were most likely to exhibit poor verbal memory

CONCLUSIONS• HIV and IDU are associated

with depression and poor QOL in women, but not men

• HIV is associated with poor verbal memory in men, but not women

SIGNIFICANCE

• Medical treatments for HIV/AIDS and IDU should be tailored to meet the specific needs of affected men and women

ACKNOWLEDGEMENTS

• Vickie Sinkler

• Rosa Sebree

• Samantha Apel

• NIH 1R01DA/DKR814-6141