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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Neurology · HIV-Associated Neurocognitive Disorder

Recognizing Symptoms and Warning Signs

At a Glance

HIV-associated neurocognitive disorder can cause gradual changes in mental speed, attention, planning, memory, language, or coordination. Sudden weakness, speech or vision changes, seizures, severe headache with fever, or severe confusion require emergency evaluation rather than waiting for a routine appointment.

Identifying cognitive changes can be challenging because symptoms of HIV-Associated Neurocognitive Disorder (HAND) are often subtle and can vary from day to day [1]. Understanding what to look for—and knowing when a symptom is a medical emergency—empowers you to seek the right care at the right time.

Common and Overlooked Symptoms

Treated HAND is heterogeneous and can involve many different areas of thinking. You may notice:

  • Mental Slowness (Processing Speed): You might feel like your brain is “lagging.” It may take longer to process information, follow a fast-paced conversation, or react to things while driving [2][3].
  • Attention and Concentration: You may find it harder to stay focused on a book or movie, or you might struggle to multitask, like cooking while talking on the phone [1][4].
  • Executive Function: This involves planning and organizing. You might have new trouble managing your monthly bills, remembering your medication schedule, or keeping track of appointments [2][5].
  • Learning, Memory, and Language: You might have trouble learning new tasks, remembering recent conversations, or finding the right words [1].
  • Motor Dexterity: Sometimes HAND shows up physically. You might notice your handwriting has changed, you are more clumsy with small objects like buttons or keys, or your movements feel slightly “stiff” [2][6].

These symptoms are non-specific, meaning they can also be caused by medications, mood, sleep issues, or vascular disease. They warrant assessment, but they are not a way for you to diagnose HAND on your own.

Illustrative Examples: Normal Aging vs. Concern

It is natural to worry about every forgotten name or misplaced set of keys. While the following table is not a diagnostic tool, it illustrates the difference between typical changes and symptoms that warrant discussion with your doctor:

Symptom Normal Aging/Stress Potential Concern
Memory Forgetting a name but remembering it later [7]. Forgetting how to perform a task you’ve done for years [2].
Processing Taking slightly longer to learn a new app. Feeling “foggy” or slowed down in almost every conversation [8].
Daily Life Occasionally missing a bill payment. Consistent trouble organizing your day or managing medications [5].
Mood Feeling irritable because you are tired. New, persistent apathy or loss of interest in hobbies [9].

When to Seek Immediate Medical Care

Most cases of HAND develop very gradually over months or years. Gradual, mild memory slips are not an emergency. However, certain symptoms are “red flags” that require an immediate medical evaluation. These signs may indicate serious complications like opportunistic infections, a stroke, or meningitis [10][11].

EMERGENCY WARNING SIGNS: Call your local emergency services (Do NOT drive yourself) If You Experience:

  • Physical Weakness: Sudden weakness or numbness, especially if it is only on one side of the body [12].
  • Vision or Speech Issues: Sudden blurred vision, loss of half your field of vision, or trouble forming words/speaking [12].
  • Seizures: Any new focal or full-body seizure [13].
  • Severe Headache or Fever: Especially if accompanied by a stiff neck, sensitivity to light, or profound confusion [14].
  • New, Profound Confusion: Sudden disorientation, not knowing where you are, or delirium [15].

URGENT (Prompt Outpatient Review): Contact your HIV clinician or neurologist soon if you experience:

  • Gradual but Noticeable Decline Over Weeks: Any cognitive or personality change that rapidly worsens over days or a few weeks [11].
  • Balance and Gait Issues: New trouble walking, frequent falling, or new loss of bladder/bowel control [11][16].

Your emergency or clinical team will decide which tests, such as an MRI, CT scan, or laboratory work, are necessary based on your presentation [11][17].

Common questions in this guide

What changes can happen with HIV-associated neurocognitive disorder?
HAND may cause slower thinking, trouble staying focused, difficulty planning or organizing, problems learning or remembering information, word-finding difficulty, and reduced coordination or dexterity. Symptoms can be subtle and may vary from day to day.
How can I tell whether forgetfulness is more than normal aging?
More concerning changes include forgetting how to perform a familiar task, consistently struggling to organize your day or manage medicines, or feeling slowed down during most conversations. These signs do not prove that you have HAND because medications, mood, sleep problems, and other health conditions can cause similar symptoms.
Which symptoms of HAND need emergency medical attention?
Call your local emergency services for sudden one-sided weakness or numbness, sudden vision or speech changes, a new seizure, or severe headache with fever, stiff neck, light sensitivity, or severe confusion. Do not drive yourself, because these symptoms can signal a stroke, infection, or another serious problem.
When should I contact my HIV clinician or neurologist promptly?
Contact your clinician soon for a noticeable cognitive or personality decline that worsens over days or weeks, new trouble walking, frequent falls, or new loss of bladder or bowel control. These symptoms may not require an ambulance, but they should not wait for a routine visit.
Could medicines or another health problem be causing my memory changes?
Yes. Medicines, depression or other mood problems, poor sleep, and vascular disease can cause symptoms that resemble HAND. Your clinician may review your medicines and consider other checks, such as vitamin B12 or thyroid testing, before attributing the changes to HIV.
What tests might be used to evaluate new cognitive or neurologic symptoms?
Evaluation may include cognitive testing, a medical and medication review, a neurologic examination, and laboratory work. Depending on the symptoms, an emergency or clinical team may also order an MRI or CT scan.

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which specific cognitive domains—like processing speed or executive function—did my tests show are affected?
  2. 2.How do my test results compare to what is expected for my age and education level?
  3. 3.Could my memory symptoms be a side effect of my current ART or other medications I am taking?
  4. 4.If I notice a sudden change in my balance or speech, whom should I call immediately?
  5. 5.Should we check my vitamin B12 levels or thyroid function before attributing these changes to HIV?

References

References (17)
  1. 1

    "I'm Just Forgetting and I Don't Know Why": Exploring How People Living With HIV-Associated Neurocognitive Disorder View, Manage, and Obtain Support for Their Cognitive Difficulties.

    Terpstra AR, Worthington C, Ibáñez-Carrasco F, et al.

    Qualitative health research 2018; (28(6)):859-872 doi:10.1177/1049732318761364.

    PMID: 29676675
  2. 2

    Changing clinical phenotypes of HIV-associated neurocognitive disorders.

    Sacktor N

    Journal of neurovirology 2018; (24(2)):141-145 doi:10.1007/s13365-017-0556-6.

    PMID: 28752495
  3. 3

    Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania.

    Fotheringham L, Lawson RA, Urasa S, et al.

    Journal of the International Neuropsychological Society : JINS 2024; (30(7)):660-670 doi:10.1017/S1355617724000201.

    PMID: 38766814
  4. 4

    Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe.

    Nyamayaro P, Gouse H, Hakim J, et al.

    BMC infectious diseases 2020; (20(1)):383 doi:10.1186/s12879-020-05090-8.

    PMID: 32471350
  5. 5

    Impact of HIV-associated cognitive impairment on functional independence, frailty and quality of life in the modern era: a meta-analysis.

    Nweke M, Mshunqane N, Govender N, et al.

    Scientific reports 2022; (12(1)):6470 doi:10.1038/s41598-022-10474-8.

    PMID: 35440802
  6. 6

    Impairments of Motor Function While Multitasking in HIV.

    Kronemer SI, Mandel JA, Sacktor NC, Marvel CL

    Frontiers in human neuroscience 2017; (11()):212 doi:10.3389/fnhum.2017.00212.

    PMID: 28503143
  7. 7

    The Immunomodulatory Effects of Plant Extracts and Plant Secondary Metabolites on Chronic Neuroinflammation and Cognitive Aging: A Mechanistic and Empirical Review.

    Kure C, Timmer J, Stough C

    Frontiers in pharmacology 2017; (8()):117 doi:10.3389/fphar.2017.00117.

    PMID: 28344556
  8. 8

    HIV-associated neurocognitive disorder.

    Smail RC, Brew BJ

    Handbook of clinical neurology 2018; (152()):75-97 doi:10.1016/B978-0-444-63849-6.00007-4.

    PMID: 29604986
  9. 9

    The comorbidity of depression and neurocognitive disorder in persons with HIV infection: call for investigation and treatment.

    Goodkin K, Evering TH, Anderson AM, et al.

    Frontiers in cellular neuroscience 2023; (17()):1130938 doi:10.3389/fncel.2023.1130938.

    PMID: 37206666
  10. 10

    HIV-Associated Neurologic Disorders and Central Nervous System Opportunistic Infections in HIV.

    Le LT, Spudich SS

    Seminars in neurology 2016; (36(4)):373-81 doi:10.1055/s-0036-1585454.

    PMID: 27643907
  11. 11

    Ethical and Clinical Considerations in the Workup of HIV-Associated Neurocognitive Decline.

    Davis K, Grant KG, Sousou JM, Ilechukwu S

    Cureus 2025; (17(11)):e97348 doi:10.7759/cureus.97348.

    PMID: 41426939
  12. 12

    Progressive multifocal leukoencephalopathy in a patient with mediastinal teratoma: a case report.

    Wang W, Yang H, Piao Y, et al.

    BMC neurology 2022; (22(1)):40 doi:10.1186/s12883-022-02563-y.

    PMID: 35086492
  13. 13

    Epileptic seizures associated with progressive multifocal leukoencephalopathy in HIV-infected patients in Korea.

    Kim HK, Kang JY, Lee SY

    Journal of neurovirology 2023; (29(3)):325-330 doi:10.1007/s13365-023-01136-0.

    PMID: 37294409
  14. 14

    Neurologic Complications of Human Immunodeficiency Virus Infection.

    Saylor D

    Continuum (Minneapolis, Minn.) 2018; (24(5, Neuroinfectious Disease)):1397-1421 doi:10.1212/CON.0000000000000647.

    PMID: 30273245
  15. 15

    Cognitive impairment in patients with AIDS - prevalence and severity.

    Watkins CC, Treisman GJ

    HIV/AIDS (Auckland, N.Z.) 2015; (7()):35-47 doi:10.2147/HIV.S39665.

    PMID: 25678819
  16. 16

    HIV-associated neurocognitive disorder and HIV-associated myelopathy in a patient with a preserved CD4, but high viral load-a rarely reported phenomenon: a case report and literature review.

    Ayele BA, Amogne W, Gemechu L

    BMC infectious diseases 2020; (20(1)):574 doi:10.1186/s12879-020-05297-9.

    PMID: 32758161
  17. 17

    Managing cognitive impairment in people with HIV.

    Alford K, O'Brien C, Banerjee S, et al.

    Current opinion in infectious diseases 2025; (38(1)):1-9 doi:10.1097/QCO.0000000000001078.

    PMID: 39602088

This page is for informational purposes only and does not constitute medical advice or diagnose HAND. Contact your HIV clinician or neurologist about persistent changes, and seek emergency care for sudden neurologic symptoms.