Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Infectious disease

Cognitive criteria in HIV: greater consensus is needed

Nature Reviews Neurology volume 20, pages 127–128 (2024)Cite this article

Subjects

Access through your institution
Buy or subscribe

A recently published Consensus Statement by Sam Nightingale and colleagues (Nightingale, S. et al. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat. Rev. Neurol. 19, 424–433; 2023)1 proposes a new approach to classifying cognitive impairment in people living with HIV. Although we applaud the efforts of the authors, other considerations are needed to ensure earlier and more consistent diagnosis, prevention and enhanced patient care. Furthermore, rather than rejecting the current criteria, a careful update of the HIV-associated neurocognitive disorder (HAND) criteria2 would avoid an enormous historical loss resulting from new data becoming incomparable.

The inclusion of neuroimaging criteria could improve the diagnosis of HAND3, if standardized. However, the limitation of this inclusion is that concepts regarding ‘active’ and ‘legacy’ HIV-associated brain injury (HABI) are not well defined and would be difficult to implement without access to MRI scanners, advanced neuroimaging expertise and specific MRI sequences or markers.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Nightingale, S. et al. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat. Rev. Neurol. 19, 424–433 (2023).

    Article  PubMed  Google Scholar 

  2. Matchanova, A., Woods, S. P. & Kordovski, V. M. Operationalizing and evaluating the Frascati criteria for functional decline in diagnosing HIV-associated neurocognitive disorders in adults. J. Neurovirol. 26, 155–167 (2020).

    Article  PubMed  Google Scholar 

  3. Antinori, A. et al. Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69, 1789–1799 (2007).

    Article  CAS  PubMed  Google Scholar 

  4. McIntosh, R. C. et al. The evolution of assessing central nervous system complications in human immunodeficiency virus: where do we go from here? J. Infect. Dis. 227 (Suppl 1), S30–S37 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mohammadzadeh, N. et al. Lentiviral infections persist in brain despite effective antiretroviral therapy and neuroimmune activation. MBio 12, e0278421 (2021).

    Article  PubMed  Google Scholar 

  6. Suzuki, K. et al. Elevation of cell-associated HIV-1 transcripts in CSF CD4+ T cells, despite effective antiretroviral therapy, is linked to brain injury. Proc. Natl Acad. Sci. USA 119, e2210584119 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Angelovich, T. A. et al. Regional analysis of intact and defective HIV proviruses in the brain of viremic and virally suppressed people with HIV. Ann. Neurol. 94, 798–802 (2023).

    Article  PubMed  Google Scholar 

  8. Isherwood, S. J. S., Bazin, P. L., Alkemade, A. & Forstmann, B. U. Quantity and quality: normative open-access neuroimaging databases. PLoS ONE 16, e0248341 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Sheppard, D. P. et al. Elevated rates of mild cognitive impairment in HIV disease. J. Neurovirol. 21, 576–584 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Edmonds, E. C., Delano-Wood, L., Galasko, D. R., Salmon, D. P. & Bondi, M. W. Subtle cognitive decline and biomarker staging in preclinical Alzheimer’s disease. J. Alzheimers Dis. 47, 231–242 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank people with lived experience of HIV and HAND who have shared their stories with us. We thank the community organizations who are working with us to address the needs of people living with HIV and HAND. We thank members of the NeuroHIV Aging and Advocy Group for their constructive discussion about cognitive health in people living and aging with HIV that have helped to inform the current Correspondence.

Author information

Author notes

  1. These authors jointly supervised this work: Lucette A. Cysique, Sean B. Rourke.

Authors and Affiliations

  1. School of Psychology, University of New South Wales, Sydney, New South Wales, Australia

    Lucette A. Cysique

  2. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital (Unity Health Toronto), Toronto, Ontario, Canada

    Lucette A. Cysique & Sean B. Rourke

  3. Peter Duncan Neuroscience Research Unit, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia

    Lucette A. Cysique & Bruce J. Brew

  4. The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia

    Lucette A. Cysique & Htein Linn Aung

  5. Sydney St Vincent’s Hospital Sydney, Sydney, New South Wales, Australia

    Lucette A. Cysique & Bruce J. Brew

  6. Positive Women Inc., Auckland, Aotearoa New Zealand

    Jane Bruning

  7. Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Desiree Byrd & Monica Rivera Mindt

  8. Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA

    Desiree Byrd

  9. Positive Life New South Wales, Sydney, New South Wales, Australia

    Jane Costello

  10. School of Psychology & Wellbeing, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia

    Kirstie Daken & Amy B. Mullens

  11. Department of Psychiatry, University of California San Diego, San Diego, CA, USA

    Ronald J. Ellis, Robert K. Heaton, Scott Letendre, David Moore & Mattia Trunfio

  12. School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA

    Pariya L. Fazeli & David E. Vance

  13. Department of Psychiatry and Institute of Neuroscience, University of Texas Rio Grande Valley, Edinburg, TX, USA

    Karl Goodkin

  14. Department of Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA

    Hetta Gouse

  15. National AIDS Treatment Advocacy Project, New York, NY, USA

    Jules Levin

  16. Department of Psychology, Latin American Latino Studies, and African and African American Studies, Fordham University, New York, NY, USA

    Monica Rivera Mindt

  17. Department Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil

    Sérgio Monteiro de Almeida

  18. Infectious Diseases Department, Germans Trias Hospital, Spain Open University of Catalonia, Barcalona, Spain

    Jose A. Muñoz-Moreno

  19. Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada

    Chrispher Power

  20. HIV Center for Clinical and Behavioral Studies, Columbia University and the New York State Psychiatric Institute, New York, NY, USA

    Reuben N. Robbins

  21. National Association of People with HIV Australia, Newtown, New South Wales, Australia

    John Rule

  22. Department of Medicine and Centre of Excellence for Research in AIDS, Universiti Malaya, Kuala Lumpur, Malaysia

    Reena Rajasuriar & Pui Li Wong

  23. Mailman Department of Public Health, Columbia University, New York, NY, USA

    Micah J. Savin

  24. HIV+Aging Research Project-Palm Springs, Palm Springs, CA, USA

    Jeff Taylor

  25. Infectious Diseases Unit, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy

    Mattia Trunfio

  26. Department of Psychology, University of Houston, Houston, TX, USA

    Steven P. Woods

  27. Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia

    Edwina J. Wright

  28. Burnet Institute, HIV Elimination Program, Melbourne, Victoria, Australia

    Edwina J. Wright

  29. Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, Victoria, Australia

    Edwina J. Wright

  30. The Peter Doherty Institute of Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia

    Edwina J. Wright

  31. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Sean B. Rourke

Authors
  1. Lucette A. Cysique
    View author publications

    Search author on:PubMed Google Scholar

  2. Bruce J. Brew
    View author publications

    Search author on:PubMed Google Scholar

  3. Jane Bruning
    View author publications

    Search author on:PubMed Google Scholar

  4. Desiree Byrd
    View author publications

    Search author on:PubMed Google Scholar

  5. Jane Costello
    View author publications

    Search author on:PubMed Google Scholar

  6. Kirstie Daken
    View author publications

    Search author on:PubMed Google Scholar

  7. Ronald J. Ellis
    View author publications

    Search author on:PubMed Google Scholar

  8. Pariya L. Fazeli
    View author publications

    Search author on:PubMed Google Scholar

  9. Karl Goodkin
    View author publications

    Search author on:PubMed Google Scholar

  10. Hetta Gouse
    View author publications

    Search author on:PubMed Google Scholar

  11. Robert K. Heaton
    View author publications

    Search author on:PubMed Google Scholar

  12. Scott Letendre
    View author publications

    Search author on:PubMed Google Scholar

  13. Jules Levin
    View author publications

    Search author on:PubMed Google Scholar

  14. Htein Linn Aung
    View author publications

    Search author on:PubMed Google Scholar

  15. Monica Rivera Mindt
    View author publications

    Search author on:PubMed Google Scholar

  16. David Moore
    View author publications

    Search author on:PubMed Google Scholar

  17. Amy B. Mullens
    View author publications

    Search author on:PubMed Google Scholar

  18. Sérgio Monteiro de Almeida
    View author publications

    Search author on:PubMed Google Scholar

  19. Jose A. Muñoz-Moreno
    View author publications

    Search author on:PubMed Google Scholar

  20. Chrispher Power
    View author publications

    Search author on:PubMed Google Scholar

  21. Reuben N. Robbins
    View author publications

    Search author on:PubMed Google Scholar

  22. John Rule
    View author publications

    Search author on:PubMed Google Scholar

  23. Reena Rajasuriar
    View author publications

    Search author on:PubMed Google Scholar

  24. Micah J. Savin
    View author publications

    Search author on:PubMed Google Scholar

  25. Jeff Taylor
    View author publications

    Search author on:PubMed Google Scholar

  26. Mattia Trunfio
    View author publications

    Search author on:PubMed Google Scholar

  27. David E. Vance
    View author publications

    Search author on:PubMed Google Scholar

  28. Pui Li Wong
    View author publications

    Search author on:PubMed Google Scholar

  29. Steven P. Woods
    View author publications

    Search author on:PubMed Google Scholar

  30. Edwina J. Wright
    View author publications

    Search author on:PubMed Google Scholar

  31. Sean B. Rourke
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Lucette A. Cysique.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cysique, L.A., Brew, B.J., Bruning, J. et al. Cognitive criteria in HIV: greater consensus is needed. Nat Rev Neurol 20, 127–128 (2024). https://doi.org/10.1038/s41582-024-00927-1

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41582-024-00927-1

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing