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Exercise could protect against cognitive impairment in women with HIV

Physical activity may protect against cognitive impairment in women living with HIV, according to a study. Researchers at the Weill Institute for Neuroscience, University of California – San Francisco and the department of neurology and division of infectious diseases, University of California – San Francisco completed a cross-sectional analysis of the HIV Infection, Aging, and Immune Function Long-Term Observational Study for a neuro-cognitive evaluation to analyse the relationship between cardio-metabolic risk factors and cognitive impairment. Data collection included demographic information, neuro-psychological tests, laboratory data, physical examinations, medication usage, and physical activity questionnaires.

Of the participants (N=988), the average age was 52 years old, 20% were female, 49% were white, 49% had achieved a college degree, 90% had an undetectable HIV-viral load, and women had a higher CD4 count than men (747 cells/mm3 vs 639 cells/mm3, P <.001).

Cardiovascular risk factors included 36% of the cohort on an anti-hypertensive medication, 27% of the cohort on a statin, and 13% of the cohort with diabetes mellitus. Women had higher total cholesterol (P =.027), haemoglobin A1c (P=.078), body mass index, and waist circumference when compared to men. Women were also less likely to be physically active (P =.005) and more likely to meet the criteria for cognitive impairment (P =.003).

As a whole cohort, having HDL greater than 55 mg/dL decreased the risk for cognitive impairment by 40% (OR, 0.59; 95% CI, 0.40-0.88; P =.009), but this association was not significant when broken down by sex.

In a logistic regression model, physical activity was a protectant against cognitive impairment in women (OR, 0.33; P =.003), and in a multivariable model, physical activity had a significant relationship with decreasing the risk of cognitive impairment in women (P =.049).

Future studies need to address causality and potential unmeasured confounders and increase the number of women included in the sample size.

In conclusion, sex-related differences do appear to exist in the relationship between cardio-metabolic risk factors and cognitive impairment. The ability of physical activity to reduce the risk of cognitive impairment is a practical way to improve the health of women living with HIV.

Abstract
Background: Cardiovascular comorbidities are risk factors for human immunodeficiency virus (HIV)–associated cognitive impairment. Given differences in cardiometabolic risk profiles between women and men with HIV, we investigated whether associations between cardiometabolic risk factors and prevalent cognitive impairment differ by sex.
Methods: Separate logistic regression models were constructed for women and men at entry into a prospective study of older persons with HIV (PWH) to assess the association of cardiometabolic and other risk factors with cognitive impairment.
Results: Of 988 participants, 20% were women. Women had higher total cholesterol (194 vs 186 mg/dL; P = .027), hemoglobin A1c (5.9% vs 5.7%; P = .003), and body mass index (30.8 vs 27.4 kg/m2; P < .001) compared with men, and were less physically active (43% vs 55%; P = .005). In a multivariable model, physical activity was associated with lower odds of cognitive impairment in women (odds ratio, 0.35 [95% confidence interval, .15–.80]; P = .013) but not men.
Conclusions: Physical activity may have a greater positive impact on cognitive health in women than in men with HIV. This finding should be confirmed in studies examining the longitudinal association between physical activity and incident cognitive impairment in PWH and the effect of interventions that increase physical activity on cognitive impairment in women with HIV.

Authors
Felicia C Chow Akintomiwa Makanjuola Kunling Wu Baiba Berzins Kwang-Youn A Kim Adesola Ogunniyi Ronald J Ellis Kevin Robertson Katherine Tassiopoulos Babafemi O Taiwo

[link url="https://www.infectiousdiseaseadvisor.com/hivaids-advisor/improving-cognition-in-people-living-with-hiv/article/796097/"]Infectious Disease Advisor material[/link]
[link url="https://academic.oup.com/jid/advance-article-abstract/doi/10.1093/infdis/jiy503/5075993?redirectedFrom=fulltext"]The Journal of Infectious Diseases abstract[/link]

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