HIV-Associated Dementia: Current Diagnostic Challenges and Implications for Comprehensive Care. A Narrative Review

Abstract

Introduction: HIV-associated dementia (HAD) has become less frequent in the antiretroviral therapy era, but its diagnosis and management pose new challenges because of aging, multimorbidity, and the diverse causes of cognitive impairment among people with HIV. Objective: To characterize HAD in the current context, considering its clinical, neurocognitive, and psychosocial features, as well as current diagnostic challenges and implications for comprehensive care. Methods: The review followed SANRA criteria. Searches were conducted from April to August 2026 in PubMed/MEDLINE, Scopus, Web of Science, and Embase, primarily covering publications from January 2022 to August 2026; 30 publications were included in the synthesis. Results: The evidence indicates a decline in severe forms of HIV-related neurocognitive impairment, alongside increasing complexity in attributing dementia specifically to HIV. The Frascati criteria remain an important research framework, although their limitations have prompted contemporary approaches that place greater emphasis on clinical course, functional impairment, and differentiation from alternative etiologies. Brief cognitive screening tools cannot replace comprehensive neuropsychological, functional, and etiological assessment. Care should integrate virological control, management of comorbidities, mental health care, rehabilitation, and family and social support through interdisciplinary coordination. Evidence specifically focused on HAD remains limited compared with the broader literature on neurocognitive impairment and is characterized by diagnostic and geographical heterogeneity. Conclusions: Although HAD is less frequent today, its recognition and management require individualized, multidimensional, and interdisciplinary assessment and care.