1. HIV INFECTION AND INJECTION DRUG USE: The Importance of Gender 1 Amy B. Wisniewski, Ph.D. 2 Adrian S. Dobs, M.D., MPH Departments of Pediatrics 1 and Medicine 2

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

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

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

5. The National Academy of Sciences recommends that health research include men and women Researchers should analyze their data for sex differences

6. Depression, poor QOL and cognitive impairment are known consequences of HIV/AIDS Women, in general, report more depressive symptoms than men

7. STUDY DESIGN Men and Women matched by Age Race Education SES IDU Outcome Measures Depression –CESD QOL –MOS-HIV Cognition –Verbal memory –Perceptual speed

8. PARTICIPANTS Gender Male N (%) 31 (51) Female30 (49) HIV status HIV+27 (44) HIV-34 (56) IDU status IDU+31 (50) IDU-30 (49) Education > 12 th grade40 (66) < 12 th grade21 (34)

9. PARTICIPANTS MalesFemales HIV-IDU-98 HIV+IDU-96 HIV-IDU+510 HIV+IDU+86

10. RESULTS More women than men reported depression (CESD > 16)

11. Women who were both HIV+ and IDU+ were the most likely to report depression (CESD > 16)

12. Women were more likely to show poor (lower) QOL/physical health scores than men, when adjusted for HIV and IDU.

13. HIV+ participants were more likely to show poor (lower) QOL/physical health scores than HIV- participants.

14. HIV+ participants were more likely to show poor (lower) QOL/mental health scores than HIV- participants.

15. COGNITIVE SCORES In general, women outperform men on tests of verbal memory In general, HIV- outperform HIV+ participants on measures of perceptual speed

16. HIV STATUS AND GENDER INTERACT HIV - women perform best, and HIV + men perform the worst on a test of delayed verbal memory (p <.05).

17. 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 +

18. Women and HIV + participants were most likely to report poor QOL scores HIV + men were most likely to exhibit poor verbal memory

19. 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

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

21. ACKNOWLEDGEMENTS Vickie Sinkler Rosa Sebree Samantha Apel NIH 1R01DA/DKR814-6141