Abstract
Cognitive impairment remains frequent and heterogeneous in presentation and severity among virally suppressed (VS) women with HIV (WWH). We identified cognitive profiles among 929 VS-WWH and 717 HIV-uninfected women from 11 Women's Interagency HIV Study sites at their first neuropsychological (NP) test battery completion comprised of: Hopkins Verbal Learning Test-Revised, Trail Making, Symbol Digit Modalities, Grooved Pegboard, Stroop, Letter/Animal Fluency, and Letter-Number Sequencing. Using 17 NP performance metrics (T-scores), we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores and clustering those nodes. Among VS-WWH, nine clusters were identified (entropy = 0.990) with four having average T-scores ≥45 for all metrics and thus combined into an “unimpaired” profile (
n
= 311). Impaired profiles consisted of weaknesses in: (1) sequencing (
Profile-1
;
n
= 129), (2) speed (
Profile-2
;
n
= 144), (3) learning + recognition (
Profile-3
;
n
= 137), (4) learning + memory (
Profile-4
;
n
= 86), and (5) learning + processing speed + attention + executive function (
Profile-5
;
n
= 122). Sociodemographic, behavioral, and clinical variables differentiated profile membership using Random Forest models. The top 10 variables distinguishing the combined impaired vs. unimpaired profiles were: clinic site, age, education, race, illicit substance use, current and nadir CD4 count, duration of effective antiretrovirals, and protease inhibitor use. Additional variables differentiating each impaired from unimpaired profile included: depression, stress-symptoms, income (
Profile-1
); depression, employment (
Profile 2
); depression, integrase inhibitor (INSTI) use (
Profile-3
); employment, INSTI use, income, atazanavir use, non-ART medications with anticholinergic properties (
Profile-4
); and marijuana use (
Profile-5
). Findings highlight consideration of NP profile heterogeneity and potential modifiable factors contributing to impaired profiles.
