HIV infections can travel to the brain and cause dementia or other cognitive impairment. Treatment may include effective antiretroviral therapy (ART), antidepressants, antipsychotics, stimulants, or lifestyle changes.

When HIV-related cognitive issues are treated as soon as possible, there’s the greatest chance of recovery. Let’s look at the symptoms to watch for and available treatment options.

Without proper treatment, HIV infections can spread to the brain and cause cognitive impairment and, eventually, dementia. When dementia develops as a result of HIV, it’s referred to as “HIV-associated dementia” (HAD).

Researchers in 2022 found cognitive deficits in up to 40% of people with HIV. An estimated 1 out of 1,000 people living with HIV who aren’t treated with antiretroviral therapy (ART) will eventually have dementia.

People with a history of drug or alcohol misuse are more likely to have severe HAD symptoms. Those who are in an ART program for HIV treatment, meanwhile, are less likely to get dementia.

Like with other forms of dementia, the risk of developing HAD appears to go up with age.

How common is dementia in those with HIV?

HIV is the most common cause of dementia in young American adults.

People more than 50 years of age with HIV also have a 58% higher risk of dementia than people more than 50 years of age without HIV, 2022 research shows.

Meanwhile, neurocognitive issues are a complaint in an estimated 4–15% of people with HIV overall. “HIV encephalopathy” refers to an infection that affects the brain and may cause a gradual escalation of neurocognitive impairment, including:

  • asymptomatic neurocognitive impairment
  • minor neurocognitive disorder
  • HAD
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HAD may cause the following signs and symptoms:

Because HAD symptoms may be very similar to other medical conditions, it’s a good idea to visit a doctor for a diagnosis.

HAD is reversible, especially when treated in its earliest stages.

According to 2022 research, committing to and sticking with ART shows improvement in the brain function of people with HAD, even in those with severe impairments. The occurrence of HAD has also reduced over time with the use of ART.

Effective ART typically includes ongoing, daily antiretroviral medication and regular lab work to treat the infection and stop HIV’s progression. The program is tailored to the person’s needs, and by strengthening the immune system, it can often make the virus nearly symptomless.

Thanks to ART, HAD is now a rare condition. In the United States, the risk of HAD has decreased over the years from 15–20% of people with HIV before ART to just 1–2% after ART. Overall, the incidence of HAD has dropped by almost half since the introduction of ART.

For that reason, screening early for cognitive impairment is recommended for all people living with HIV. Sticking with ART and other treatments as recommended by a doctor will also effectively manage symptoms and prevent the condition from worsening.

Complementary treatments may include:

  • substance or alcohol misuse counseling, if necessary
  • medication (i.e., antidepressants, antipsychotics, stimulants)
  • lifestyle changes (i.e., exercise, taking notes to boost memory, relaxation techniques)
  • other coping strategies (i.e., support groups, hiring a caregiver)

How does HAD affect life expectancy?

According to 2022 research, the mean HAD survival rate without using ART was 3–6 months. When ART was introduced in the 90s, continued use of the program increased the survival rate for people with HAD to 38.5 months.

That said, treatment is much more effective in the earlier stages of HIV-associated neurocognitive disorders. Although there’s a lack of precise data, modern treatment has also significantly improved the outlook for people with HIV overall.

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If you think you might have HAD, you deserve support.

Here are some tips for taking the best next steps for your well-being:

  • Talk with a doctor about any issues with memory, concentration, or communication.
  • Reach out to an HIV specialist with experience testing for and treating HAD.
  • If your condition is diagnosed as HAD, consider counseling or joining a support group for emotional support.
  • If in the United States, use the ICD-10 code F02.4 for dementia in HIV disease for insurance purposes.
  • If you don’t have insurance, you still have options. Consider enrolling in a patient assistance program or government program like Medicaid.
  • The Ryan White HIV/AIDs Program also has many resources to support your healing journey. You may want to start by calling 800-448-0440 from the United States or Canada or finding your state’s local hotline online.

HAD occurs when the effects of HIV spread to the brain. Symptoms include difficulty thinking, concentrating, talking, or moving as usual.

When treated with ART, HIV and HAD are highly manageable. Taking medication daily and sticking to your individualized treatment plan can help ensure that HIV symptoms, including cognitive impairment, don’t worsen. Your symptoms may even improve.

Support groups, counseling, and healthy lifestyle changes can also help you with your condition and ensure that you live well.