Cardiometabolic and cerebrovascular disease are strong independent contributors to cognitive irmpairment in people living with HIV (PWH). Data suggest that cardiovascular risk may play a greater role in cognitive health in women than men with HIV.We performed a cross-sectional study of 104 participants with virologically suppressed HIV from two clinics in urban China. Participants underwent neuropsychological testing from which we calculated T-scores globally and in 5 cognitive domains. We assessed cerebral vasoreactivity of the middle cerebral arteries in response to breath-holding. We constructed linear regression models to determine associations between cerebrovascular and cognitive function overall and stratified by sex.Women were younger than men (48 versus 51 years, p=0.053), had fewer years of education (9 years versus 12 years, p=0.004), and fewer cardiometabolic risk factors (0 versus 1 factor, p=0.008). In a model with all participants, cerebrovascular function was significantly associated with global cognition (2.74 higher T-score per 1-point higher cerebral vasoreactivity [SE 1.30], p=0.037). Cerebrovascular function remained significantly associated with global cognition among women (4.15 higher T-score [SE 1.78], p=0.028) but not men (1.70 higher T-score [SE 1.74], p=0.33). The relationships between cerebrovascular function and specific cognitive domains followed a similar pattern, with significant associations present among women but not men.Women with well-controlled HIV may be more vulnerable to the impact of cerebrovascular injury on cognitive health than men. Studies evaluating strategies to protect against cognitive impairment in PWH should include adequate representation of women and stratification of analyses by sex.