Implications and prospects of immunological and neuroimaging research in HIV-associated neurocognitive disorders

Combination antiretroviral therapy effectively controls viral replication in HIV-infected individuals, yet cognitive and motor impairments persist in 30-60% of patients, contributing to HIV-associated neurocognitive disorders (HAND). Current diagnostic approaches, such as the Frascati criteria, remain limited by practicality and sensitivity. Integrating neuroimaging with immunological markers may enhance early detection and mechanistic understanding.

We conducted a literature search in PubMed and Web of Science for articles published between 1990 and 2024, using keywords including "HIV-associated neurocognitive disorders," "HIV," "immunity," "neuroimaging," and "treatment." Additional relevant publications were identified through manual review of reference lists.

This review synthesizes current epidemiology, diagnostic methods, and neuroimmune mechanisms underlying HAND. It summarizes available neuroimaging techniques and associated biomarkers, emphasizing progress in combining neuroimaging with immunology to identify structural and functional neural changes. Abnormal neuroimaging findings coupled with immunological markers show promise for earlier detection compared to cognitive assessments alone.

We highlight the systemic connections between early HAND diagnosis and the synergistic use of neuroimaging and immunology, identifying candidate biomarkers in HAND pathogenesis. Furthermore, we discuss emerging treatment strategies and the relevance of early detection in the context of potential HIV eradication.