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New guidelines on cognitive impairment in people living with HIV

New guidelines on cognitive impairment in people living with HIV
New guidelines on cognitive impairment in people living with HIV

Simon Collins, HIV i-Base

New international consensus guidelines have been published that update earlier documents related to the diagnosis and management of neurocognitive impairment in people living with HIV.

They aim to correct the earlier potential for overdiagnosis linked to HIV Associated Neurocognitive Disease (HAND) criteria and focus on differentiating between HIV and numerous other causes.

The new guidelines propose using HIV-associated brain injury (HABI) as a new term for cases where HIV directly causes complications and highlight that low performance of neurocognitive testing can result from social, educational and language skills rather than any active injury.

The document also emphasises the importance of differentiating between historical archive or legacy damage and ongoing active neurological problems.

These guidelines differ from earlier criteria used in the HAND criteria by identifying HIV as the direct cause of symptoms and in requiring a clinical assessment to interpret results from neurocognitive testing.

The writing panel – the International HIV-Cognition Working Group) – included doctors, researchers and community advocates from South Africa, India, Uganda, Kenya, Zambia, Europe, the US and the UK.

Six main recommendations

  1. HIV-associated brain injury (HABI) should be considered as one cause of cognitive impairment alongside other potential causes of brain injury occurring in people living with HIV.

  2. HABI should be differentiated on the basis of HIV RNA suppression and the activity of pathology.

  3. Low performance on cognitive tests should not be labelled as cognitive impairment without clinical context.

  4. When interpreting cognitive data, the false-classification rate should be considered.

  5. A research classification of cognitive impairment in people living with HIV should consider a combination of cognitive symptoms, low performance on cognitive testing, and abnormality on neurological investigations.

  6. Cognitive symptoms should refer to any change in cognition that has been noticed by the individual or an observer, whether or not this change has an impact on daily functioning.


Nightingale S et al. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol (2023).

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