HIV-Associated Neurocognitive Disorder and CNS Viral Escape: A Case Report

HIV-associated neurocognitive disorder (HAND) encompasses a spectrum of cognitive impairments prevalent in individuals infected with HIV, despite effective combination antiretroviral therapy. This case report discusses a 42-year-old male with a history of HIV infection since 2014 who is currently on antiretroviral therapy (ART). The patient presented with cognitive impairment and generalized weakness, with subsequent investigations revealing HAND and CNS viral escape. The patient's management involved a switch to a different ART regimen, resulting in significant clinical improvement. This case highlights the importance of considering CNS-specific HIV replication in patients with neurocognitive symptoms and underscores the need for tailored ART regimens. The exclusion of progressive multifocal leukoencephalopathy through negative JC virus PCR was crucial in directing appropriate management. Comprehensive diagnostic evaluations, including CSF analysis and brain imaging, are essential for the accurate diagnosis and effective treatment of HAND, particularly in cases of CNS viral escape.