Any HIV-infected person complaining of disturbances in his/her memory (comprehension, clarity or speed) should be evaluated extensively, including neurological examination, neuropsychological assessment, cerebrospinal examination and imaging of the brain.

• Patients without such symptoms that should be targeted for screening
  
  • Uncontrolled HIV infection (detectable plasma HIV RNA)
    
  • Use of antiretroviral agents with limited CNS penetration
    
  • Low CD4 nadir (<200 cells/mm3)
    
  • Ongoing depression
    
• Screening tool
  
  • International HIV Dementia Scale (IHDS)i
    
• Interventions if neurocognitive impairment detected:
  
  • If patient is not on ART:
    
    • Consider initiation of ART in which at least 2 drugs penetrate CNSii
      
    • Consider risk for antiretroviral resistance if prior virological failure
      
  • If patient is already on ART:
    
    • Consider changing antiretroviral treatment to active drugs with better CNS penetrationii
      
    • Consider genotyping of plasma and CSF HIV RNA whenever feasible prior to changing ART