Cognitive impairment in persons with HIV: changing aetiologies and management strategies

PURPOSE OF REVIEW: Cognitive disorders have been described in persons with HIV since the advent of virologically suppressive antiretroviral therapy. As persons with HIV age, their demographics and risk factors for cognitive health have changed. Here, we review these changing demographics and the recent literature regarding risk factors for cognitive decline and best management strategies. RECENT FINDINGS: Rates on noninfectious comorbidities are higher in persons with HIV compared to those without HIV and specifically include high rates of mental health conditions and cardiovascular complications. The optimal management of these noninfectious comorbidities is crucial for maintaining brain health. The early initiation of antiretroviral therapy may prevent irreversible damage to brain health and modern integrase-strand-transfer-inhibitor based antiretroviral regimens appear to have a positive effect on cognitive health. SUMMARY: Risk factors for cognitive decline in persons with HIV have dramatically changed in recent years along with clinical management strategies. As persons with HIV globally continue to age, ongoing considerations of these risk factors and management strategies will continue to be key in maintaining brain health for the 40 million people living with HIV globally.