Transcript HIV INFECTION AND INJECTION DRUG USE: The Importance of

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 DESIGN
Men 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)
HIV status
Female
HIV+
30 (49)
27 (44)
IDU status
HIVIDU+
34 (56)
31 (50)
Education
IDU> 12th grade
30 (49)
40 (66)
< 12th grade
21 (34)
PARTICIPANTS
Males
Females
HIV-IDU-
9
8
HIV+IDU-
9
6
HIV-IDU+
5
10
HIV+IDU+
8
6
RESULTS
50
p < .05
Mean CESD Scores
45
40
35
30
25
20
15
10
5
0
Men
Women*
More women than men reported
depression (CESD > 16)
Women who were both HIV+ and
IDU+ were the most likely to report
depression (CESD > 16)
50
45
CESD Scores
40
35
30
25
20
15
10
5
0
HIV-IDU-
HIV-IDU+
HIV+IDU-
HIV+IDU+*
Mean (SEM) MOSHIV Physical Health
Factor Score
Women were more likely to show poor
(lower) QOL/physical health scores than
men, when adjusted for HIV and IDU.
60
50
p < .05
40
30
20
10
0
Women
Men
Mean (SEM) MOSHIV Physical Health
Factor Score
HIV+ participants were more likely to
show poor (lower) QOL/physical health
scores than HIV- participants.
60
50
p < .05
40
30
20
10
0
HIV-
HIV+
Mean (SEM) MOSHIV Mental Health
Factor Score
HIV+ participants were more likely to
show poor (lower) QOL/mental health
scores than HIV- participants.
60
p < .05
50
40
30
20
10
0
HIV-
HIV+
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).
90
80
70
60
50
40
30
20
10
0
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