Does HIV cause cognitive impairment?

HIV-associated neurocognitive disorder (HAND) is more common in people who started treatment with a low CD4 count. This is less common now that guidelines recommend that people start treatment right away.

If someone has started treatment with a very low CD4 count, they’re more likely to have some HIV-induced damage to the brain or an opportunistic infection that affects the brain.  

People living with HIV can experience cognitive impairment caused by HIV itself, or by factors like:

  • depression, anxiety or other mental health problems
  • conditions that reduce blood flow to the brain (such as diabetes, high cholesterol or high blood pressure)
  • excessive use of alcohol or recreational drugs
  • Alzheimer’s disease
  • an opportunistic infection such as toxoplasmosis
  • lymphoma – a type of tumour which often affects the brain
  • side effects from antiretroviral drugs, particularly efavirenz
  • neurosyphilis – untreated syphilis can cause damage to the nervous system.

There are also more subtle forms of impairment which don’t cause noticeable problems but which can be picked up by tests.

According to the Alzheimer’s Society, only around 2% of people living with HIV now experience dementia, whereas this figure was 20-30% before antiretrovirals were available.

Symptoms of cognitive impairment

HIV-related memory problems in people who are on treatment are usually at the milder end of the spectrum and many people living with HIV experience them. These problems wouldn’t generally be classed as dementia.

More severe memory problems, such as dementia, are relatively uncommon. They may be marked out by:

  • difficulties making decisions
  • short-term memory problems
  • a change in personality.

How likely are you to develop memory problems?

The risk of developing brain impairment is higher if you received a late HIV diagnosis. It also depends on your lowest ever CD4 count.

Most people are diagnosed and start treatment in good time to prevent memory impairment and in those who are experiencing it, antiretroviral treatments can sometimes reverse the problem.

Can I do anything to prevent memory problems?

You can reduce your likelihood of developing brain impairment by reducing your alcohol intake and not taking recreational drugs.

Managing stress and depression is also important.

Adopting a healthy diet, exercising, stopping smoking and losing weight if you’re overweight are good ways to avoid dementia.

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