Glucocorticoid-immune response to acute stress in women and men living with HIV.

Despite high risk for serious non-AIDS events (SNAEs) and accelerated age-related increases in inflammatory markers relative to HIV+ men, HIV+ women have been understudied, particularly in terms of stress impacts on immune parameters. The purpose of this study was to examine sex differences in glucocorticoid-immune stress response in mid-life HIV+ individuals, as poor glucocorticoid control of stress-induced inflammation may contribute to health risk in HIV+ women. Male and female participants completed a threat of shock laboratory stressor. Serum cortisol and cytokines [interleukin (IL)-6, IL-8, IL-10, IL-1ß, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interferon (IFN)-γ] were assessed at six timepoints prior to and in response to the stressor. Participants included 8 HIV- controls (n = 5 female) and 9 HIV+ (n = 5 female) who were virally suppressed. Repeated measures mixed models revealed a significant sex by HIV status by time interaction for IL-10, IL-1ß, TNF-α, and cortisol. IL-10 response, an anti-inflammatory cytokine, was larger in males than females, regardless of HIV status. TNF-α response was blunted in HIV+ individuals compared with HIV-, and specifically in HIV+ women, IL-1ß and cortisol response were blunted. Individuals living with HIV may have impaired coordination between the immune system and hypothalamic pituitary adrenal (HPA) axis. HIV+ women in particular exhibited dysregulated IL-1ß and cortisol response to acute stress. Future work should focus on relationships among proinflammatory cytokines, stress, and SNAEs in HIV, with attention to sex as a biological variable.

Pregnancy and the Acceptability of Computer-Based Versus Traditional Mental Health Treatments.

BACKGROUND: Recent recommendations urge increased depression screening in pregnant and postpartum women, potentially increasing demand for treatment. Computer-based psychotherapy treatments may address some of perinatal women's unique mental health treatment needs and barriers. MATERIALS AND METHODS: We conducted a quantitative survey of pregnant women (≥12 weeks of gestation) on preferences regarding computer-based therapies compared with traditional therapies (psychotherapy and medication). Nonpregnant women and men served as comparison groups. Participants were provided descriptions of three computer-based therapies: video telehealth therapy (VTT), computer-assisted therapy (CAT), and self-guided online therapy (SGO). Participants were asked to select all options that they would consider for treatment as well as first choice preference. The Patient Health Questionnaire-9 (PHQ-9) assessed current depressive symptomatology, and the Mini International Neuropsychiatric Interview (MINI) assessed psychiatric history. RESULTS: Participants included pregnant females (n = 111), nonpregnant females (n = 147), and males (n = 54). Among pregnant women, 77.5% (n = 86) indicated that they would consider some form of computer-based therapy for mental health treatment during pregnancy; VTT was the most commonly considered, followed by CAT and SGO. When asked to select their preferred intervention, traditional talk therapy was the first choice among all three groups, controlling for treatment history and PHQ-9 score. About one-third of pregnant women chose some form of computer-based therapy as their top choice. CONCLUSIONS: While computer-based therapies were acceptable to most pregnant women in this sample, traditional talk therapy was the preferred option. Future research should consider how to tailor computer-based therapies to the unique needs of perinatal women.

Preadolescent Adversity Programs a Disrupted Maternal Stress Reactivity in Humans and Mice.

BACKGROUND: Adverse childhood experiences (ACEs) are one of the greatest predictors of affective disorders for women. Periods of dynamic hormonal flux, including pregnancy, exacerbate the risk for affective disturbance and promote hypothalamic-pituitary-adrenal (HPA) axis dysregulation, a key feature of affective disorders. Little is understood as to how stress experienced in late childhood, defined as preadolescence, alters the programming unique to this period of brain maturation and its interaction with the hormonal changes of pregnancy and postpartum. METHODS: Preadolescent female mice were exposed to chronic stress and examined for changes in their HPA axis during pregnancy and postpartum, including assessment of maternal-specific stress responsiveness and transcriptomics of the paraventricular nucleus of the hypothalamus. Translationally, pregnant women with low or high ACEs were examined for their maternal stress responsiveness. RESULTS: As predicted, preadolescent stress in mice resulted in a significant blunting of the corticosterone response during pregnancy. Transcriptomic analysis of the paraventricular nucleus revealed widespread changes in expression of immediate early genes and their targets, supporting the likely involvement of an upstream epigenetic mechanism. Critically, in our human studies, the high ACE women showed a significant blunting of the HPA response. CONCLUSIONS: This unique mouse model recapitulates a clinical outcome of a hyporesponsive HPA stress axis, an important feature of affective disorders, during a dynamic hormonal period, and suggests involvement of transcriptional regulation in the hypothalamus. These studies identify a novel mouse model of female ACEs that can be used to examine how additional life adversity may provoke disease risk or resilience.

Considering sex and gender in Alzheimer disease and other dementias.

Suffering related to dementia is multifaceted because cognitive and physical functioning slowly deteriorates. Advanced age and sex, two of the most prominent risk factors for dementia, are not modifiable. Lifestyle factors such as smoking, excessive alcohol use, and poor diet modulate susceptibility to dementia in both males and females. The degree to which the resulting health conditions (eg, obesity, type 2 diabetes, and cardiovascular disease) impact dementia risk varies by sex. Depending on the subtype of dementia, the ratio of male to female prevalence differs. For example, females are at greater risk of developing Alzheimer disease dementia, whereas males are at greater risk of developing vascular dementia. This review examines sex and gender differences in the development of dementia with the goal of highlighting factors that require further investigation. Considering sex as a biological variable in dementia research promises to advance our understanding of the pathophysiology and treatment of these conditions.

El sufrimiento relacionado con la demencia es multifacético porque el funcionamiento cognitivo y físico se deteriora lentamente. La edad avanzada y el sexo, dos de los factores de riesgo más importantes para la demencia, no son modificables. Los factores del estilo de vida, como el fumar, el uso excesivo de alcohol y la dieta pobre modulan la susceptibilidad a la demencia tanto en hombres como en mujeres. El grado por el cual las condiciones de salud resultantes (como obesidad, diabetes tipo 2 y enfermedad cardiovascular) impactan en el riesgo de demencia varía según el sexo. Según el subtipo de demencia la relación de la prevalencia hombre mujer es diferente. Por ejemplo, las mujeres tienen mayor riesgo de desarrollar demencia tipo Enfermedad de Alzheimer, en cambio los hombres tienen mayor riesgo de desarrollar demencia vascular. Esta revisión examina las diferencias por sexo y género en el desarrollo de las demencias, con el propósito de destacar los factores que requieren de futuras investigaciones. El tener en consideración el sexo como una variable biológica en la investigación de las demencias promete avanzar en la comprensión de la fisiopatología y terapéutica de estas condiciones.

La souffrance liée à la démence est multiforme, car les fonctionnements cognitif et physique se détériorent lentement. L'âge avancé et le sexe, deux des principaux facteurs de risque de démence, ne sont pas modifiables. Les facteurs de mode de vie comme le tabagisme, l'alcoolisme et une mauvaise alimentation modulent la susceptibilité à la démence chez les hommes comme chez les femmes. L'impact des pathologies (par ex. l'obésité, le diabète de type 2 et les maladies cardiovasculaires) sur le risque de démence varie selon le sexe. Selon le sous-type de démence, la prévalence du rapport hommes/femmes diffère. Par exemple, les femmes ont plus de risque de développer une démence de type Alzheimer, tandis que les hommes ont plus de risque de développer une démence vasculaire. Cet article examine les différences de sexe et de genre dans le développement des démences afin de souligner les facteurs qui nécessitent davantage de recherche. Envisager le sexe comme une variable biologique dans la recherche sur les démences permettra de mieux comprendre la physiopathologie et le traitement de ces maladies.