Many research reports identify cognitive impairment in adults with HIV. Tracing this impairment to HIV infection itself has been elusive. This paper investigates whether physical activity and associated cardiovascular risk may underlie these reported increased rates of cognitive impairment. The study used 988 participants (20% women) with well-controlled HIV infection at entry into the AIDS Clinical Trials Group (ACTG) Protocol A5322 (HAILO). The cardiometabolic risk profiles between women and men with HIV were assessed. The mean age was 52 years; 52% of women were black and 22% white; 56% of men were white and 25% black (P < .001). Women also had fewer median years of education vs men (12 vs 14 years; P < .001). 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). Thirty-six percent were being treated with an antihypertensive medication, and 27% were on statins. Thirteen percent had diabetes mellitus, 3% had a myocardial infarction and 2% had a stroke.

Using multivariate models, the authors report that 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. In this model, similar to in the separate models, they found that having ≥3 days of physical activity in the preceding week was protective against cognitive impairment only among women and not men. In the combined cohort, HDL cholesterol was the only cardiometabolic risk factor significantly associated with cognitive impairment, with 12% lower odds of cognitive impairment for every 10 mg/dL higher HDL (95% CI, .79–.99; P = .036).

The cardiometabolic factor, physical activity, had a greater impact on cognitive health in women when compared to men. The authors observe that few women take advantage of this protection afforded by exercise. Further study and identifying Interventions that engender exercise as a life-style change are needed.