©2014 International Medical Press 1359-6535 (print) 2040-2058 (online) 1 Antiviral Therapy 2014; 19: 1-13 (doi: 10.3851/IMP2563) The incidence of HIV-associated dementia has decreased signifcantly with the introduction of combination antiretroviral therapy; however, milder or more subtle forms of neurocognitive disorders associated with HIV appear to remain common. There is a lack of consen- sus on when to screen and on which methods are most appropriate for identifying patients at risk of neuro- cognitive impairment. Multiple factors (demographic, social, genetic, psychological and medical) can play a role in its aetiology and progression, including potential central nervous system toxicity of antiviral therapy. It is important to identify these factors in order to apply relevant management strategies. In this review, we dis- cuss a series of case studies that address some of the challenges presented by the diagnosis and management of HIV-associated neurocognitive impairment in differ- ent patient types. Since the introduction of combination antiretroviral therapy (cART), the incidence of HIV-associated dementia (HAD) has decreased signifcantly, whereas the prevalence of less severe forms of HIV-associated neurocognitive (NC) disorders are reported to remain high in several cohorts [1–4], although recent studies of patients well-maintained on cART have reported lower rates of NC impairment [5]. With HIV-infected indi- viduals now living for longer, the effects of ageing and associated comorbidities may combine with the effects of HIV infection to increase the effect of NC impair- ment in this population. The pathogenic mechanisms underlying mild NC disorders remain elusive. Low nadir CD4 + T-cell count has been associated with an increased risk of NC disorders in pre- and post-cART eras [1,3,6]. Although a correlation between plasma and cerebrospinal fuid (CSF) viral load and the subsequent severity of NC disease was observed in the pre-cART era, in the cART era, the relationship between viro- logical factors and NC impairment is less clear [1–3]. Where NC impairment does develop, multiple factors (demographic, social, genetic, psychological and medi- cal) may play a role in its aetiology and progression, including potential central nervous system (CNS) toxic- ity of antiviral therapy. It is important to identify these factors in order to apply relevant management strat- egies. In addition, the assessment and management of NC outcomes in children and young people with peri- natally acquired HIV adds complexity and requires an adapted approach. Review HIV-associated neurocognitive disease: case studies and suggestions for diagnosis and management in different patient subgroups Anton Pozniak 1 *, Simon Rackstraw 2,3 , Jane Deayton 2 , Tristan Barber 4 , Steve Taylor 5 , Hadi Manji 6 , Diane Melvin 7 , Michelle Croston 8 , Sam Nightingale 9 , Ranubabu Kulasegaram 10 , Mervi Pitkanen 10 , Alan Winston 7 1 Chelsea & Westminster Hospital, London, UK 2 Barts & The London NHS Trust, London, UK 3 Mildmay UK, London, UK 4 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK 5 Birmingham Heartlands Hospital, Birmingham, UK 6 University College London, London, UK 7 St Mary’s Hospital, London, UK 8 North Manchester General Hospital, Manchester, UK 9 Liverpool University, Liverpool, UK 10 St Thomas’ Hospital, London, UK *Corresponding author e-mail: anton.pozniak@chelwest.nhs.uk Introduction