It is recommended that PLHIV be questioned and screened annually about any changes to cognition or memory decline (23). If any symptoms are identified, HIV neurology review should be considered. In the short-term strategies should be discussed with the person to treat symptoms. If the person is then diagnosed with cognitive impairment the person should be provided with a clear pathway for supports (23).
There are several screening tools for HAND, such as the Montreal Cognitive Assessment, Cogstate (24) and the International Dementia Scale (25). but there is no one tool which can be used across all settings (26). Some tests are sensitive to moderate but not to mild cognitive decline (27). Additionally, performance on these tests can be culture bound/based and may vary between groups with different sociodemographic and educational backgrounds (28). The Mini Mental Status Exam (MMSE) (28) is not useful in this context as HIV cognitive impairment affects the sub-cortex of the brain, but the MMSE can be used to screen for other forms of cognitive impairment such as Alzheimer’s disease. If clinical neurological examination is not freely available, asking PLHIV and their caregivers about changes to their activities of daily living and mood is a useful starting point.
No known biological markers have been identified to support a definitive diagnosis of HAND. (27). The gold standard for HAND diagnosis is formal neuropsychological tests completed by a specially trained clinical neuropsychologist with or without radiological tests such as magnetic resonance imaging (MRI) (29). Therefore, multiple detection methods such as clinical review, functional review and neurological imaging are necessary.
The diagnosis of HAND is also often made through a process of excluding other conditions (e.g. excluding new opportunistic infections such as progressive multifocal leukoencephalopathy, and cryptococcal meningitis (18). This approach presents challenges for clinicians as there are several confounding and comorbid conditions such as depression or alcohol-related brain damage that may complicate the diagnosis. Further, PLHIV may downplay their signs and symptoms, or their caregivers may attribute behaviours to other causes such as ageing or poor mental health.