Managing cognitive impairment in people with HIV

To describe patient-centred multiciplinary management and care of people with HIV presenting with cognitive disorders.

In the era of effective antiretroviral therapy a comprehensive, multifactorial approach to assessing and managing cognitive impairment in people with HIV is required. The complexity of cognitive disorders in this population demands more than current guidelines offer, which focus primarily on HIV management, overlooking broader clinical, psychological, and social factors. Key recommendations include the integration of medical history, physical examinations, brain imaging (especially MRI), neuropsychological testing, and lumbar puncture to identify underlying causes of cognitive decline. Pharmacological treatments for HIV-related cognitive decline remain ineffective, making nonpharmacological interventions, such as cognitive training and holistic rehabilitation programs, essential for managing symptoms. Additionally, the review calls for early detection through routine screening, monitoring, and preventive care. Social and psychological support are emphasized as critical factors in addressing the mental health issues exacerbated by cognitive decline in people with HIV. Emerging models of care, such as integrated, multidisciplinary clinics, show promise in delivering comprehensive, patient-centered care that addresses both cognitive issues and broader quality of life.

This review underscores the need for a holistic, multifaceted approach to managing cognitive impairment in people with HIV, integrating clinical, psychological, and social interventions alongside HIV treatment. Given the lack of effective pharmacological options, early detection, prevention, and nonpharmacological strategies are critical in optimizing quality of life and maintaining cognitive function in this vulnerable population.