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HIV and the Brain

April 8, 2015

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HIV and the Brain

Table of Contents


The brain is a very important organ. It controls every function in our bodies and allows us to think, see, feel, touch, hear, smell, and move. The brain and the spinal cord make up the central nervous system (CNS).

While we do not know exactly how it happens, scientists believe that HIV enters the CNS within the first few weeks or months after a person is infected. Afterwards, the virus can lie hidden and inactive in the brain for a long time. Research studies have recently shown that the earlier people start HIV drugs once they know they are living with HIV (HIV+), the less likely the fluid in the CNS (called cerebrospinal fluid, or CSF) is to contain inflammatory elements and the less likely brain cells are to be damaged.

Sometimes HIV can cause damage to important parts of the CNS. Damage to cells in certain sections of the brain can lead to mild cognitive (thinking) problems including difficulty concentrating, confusion, and memory loss. However, this generally does not happen unless you have had HIV for a long time, have not been taking HIV drugs, or have been living with a very high viral load. This can lead to more severe HIV-associated dementia. Dementia is a long-lasting condition that can include memory loss, problems with reasoning, and personality changes.

HIV-Associated Brain Problems

Mild cognitive problems are not uncommon in people living with HIV. HIV-associated neurocognitive disorder (HAND) is a term used to describe a group of syndromes that include some combination of thinking, movement, mood, and/or behavior problems. Minor cognitive motor disorder (MCMD), mild neurocognitive disorder (MND), asymptomatic neurocognitive impairment (ANI), and HIV-associated dementia (HAD) are all forms of HAND. These symptoms usually only occur in people who have had HIV for a long time, have not been taking HIV drugs, or have been living with a very high viral load.

One of the more common forms of HAND is minor cognitive motor disorder. MCMD's symptoms can include a slightly reduced ability to think clearly, remember things, or perform eye-hand coordinated movements. MCMD can also include small changes in behavior or mood. This disorder is mild and can be mistaken as part of the aging process. Approximately one in every three HIV+ people will have symptoms of MCMD.

Asymptomatic neurocognitive impairment is a condition in which testing shows an HIV-associated reduction in thinking abilities which does not affect everyday function. Mild neurocognitive disorder is a condition in which testing shows an HIV-associated reduction in thinking abilities that does mildly affect how a person functions on a day-to-day basis.

A more serious condition called HIV-associated dementia (HAD) occurs less frequently, especially since newer HIV drugs have become available. People who have a CD4 cell count below 200 are at risk of developing HAD - generally the lower the CD4 count, the greater the risk. Also, having a high viral load in the blood or in the spinal fluid can increase the risk of developing HAD.

HAD is not really a disease, but a mental and physical state in which a person cannot perform normal activities of daily living without assistance (e.g., counting money, taking medications, preparing meals). HAD can show up suddenly as a dramatic change in behavior, thinking, and movement or MCMD can progress to HAD as the immune system gradually declines. However, MCMD does not necessarily progress to dementia.

Diagnosing HAND

The initial signs of HAND can be very difficult to notice. If you are experiencing memory problems or your family and friends comment on changes in your behavior or coordination, it is a good idea to start keeping a log. Note any problems you are having with:

  • Balance or coordination
  • Vision
  • Memory
  • Concentration or attention
  • Completing tasks
  • Getting lost in familiar places
  • Forgetting telephone numbers
  • Simple math

It will be important to bring this log to talk over with your health care provider as soon as possible. Even if you feel there is an explanation for the problems, it is important to tell your provider.

If your health care provider believes you may have memory loss, he or she will likely refer you to a specialist such as a neurologist (a physician who specializes in the brain and nervous system), a psychiatrist, or a neuropsychologist (a professional who specializes in testing how the mind functions) for a complete exam. This will include "neurocognitive" testing (tests of your memory and concentration, reasoning, coordination, and problem solving). These tests can detect small changes in your cognitive ability and provide important information.

You may also need to have a blood test called a lumbar puncture (also known as a spinal tap) to obtain a sample of cerebrospinal fluid. A needle is inserted between the bones of the spine and a small amount of fluid is removed. Lumbar punctures are done with local pain medication so there is not a great deal of pain. Many HIV+ patients avoid getting this procedure because it sounds frightening, but the information gained can be very helpful in making a diagnosis and selecting treatments.

Often, diagnosing HAND is a process that involves making sure your problems with memory or thinking are not the result of other, more common causes. There are many factors other than HIV that can cause mental function changes. Based on your test results, your provider can identify certain conditions or problems that may be causing these changes, such as depression or other psychological problems, tumors, excessive fluid in the brain, or injury to the brain.

HIV+ people with a weak immune system may also be at risk for opportunistic infections of the CNS such as:

  • Neurosyphilis (syphilis in the brain)
  • Cryptococcal Meningitis
  • Mycobacterium avium complex (MAC)
  • Tuberculosis (TB)
  • Toxoplasmosis (Toxo)
  • Cytomegalovirus (CMV)
  • Primary CNS lymphoma
  • Progressive Multifocal Leukoencephalopathy (PML)

Some of these conditions may be treatable with drugs, therapy, or other medical interventions. If these conditions are found not to be the cause of your symptoms, your health care provider may conclude that you are experiencing a form of HAND.

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This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.

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