Currently the most frequently used criteria for assessing cognitive impairment in people living with HIV are the HIV-associated neurocognitive disorders (HAND) criteria, developed in 2007 by a working group convened by the US National Institute of Mental Health. The HAND criteria have been successful in standardising research and practice over the last 15 years.

However, over the last two decades HIV disease has changed dramatically. Most people living with HIV are now virally supressed by effective ART and reaching life expectancies similar to uninfected populations. Now many authours argue that the HAND criteria overestimate disease burdened in our modern context, and especially in our African context where test scores can be culture-bound.

For the first time ever we are leading the global agenda in how we understand  cognitive impairment in people living with HIV. And as the country most burdened by HIV in the world, it makes sense that we have substantial insight. The International HIV-Cognition Working Group was initiated by Assoc Professor Sam Nightingale and colleagues from the HIV Mental Health research unit and aimed to outline a new diagnostic approach for cognitive impairment in people living with HIV. The Working group is globally representative, with preference given to experts from low and middle-income countries with high HIV prevalence and experts with direct clinical experience with people living with HIV as well as community representatives of people living with HIV.

Overall, the working group aims to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies ­– an example of local experts leading in the HIV field.

The consensus statement for a new approach to cognitive impairment can be found online.

Written by Morgan Watson