A recent HIV conference highlighted that even when the virus is well‑controlled, bits of it can stay active in the brain and spinal fluid, which may contribute to mental and cognitive problems. Researchers found connections between these issues and things like artery inflammation, genetic risk for Alzheimer’s, pollution exposure, and faster biological aging. They also reported early trial data on drugs such as tesamorelin, which is being tested to see if it can help protect the brain in people with HIV.

The 2024 Conference on Retroviruses and Opportunistic Infections featured new and impactful findings about neuropsychiatric complications in people with HIV and other infections. Reports included new evidence from low- and middleincome countries, HIV persistence in the central nervous system, aging-related complications (including cerebrovascular disease), additional data relevant to pathogenesis, and therapeutics. Also included were new evidence of active HIV RNA transcription in cells from cerebrospinal fluid and the brain during virally suppressive antiretroviral therapy as well as links between neuropsychiatric complications or brain imaging findings in people with HIV and a) carotid artery inflammation and cerebrovascular disease, b) Alzheimer's disease genetic risk, c) social determinants of health, including exposure to pollution, and d) epigenetic aging. New therapeutic findings were presented on the cerebrospinal fluid inhibitory quotient, the effects of polypharmacy, and clinical trials of tesamorelin and telmisartan. This review summarizes these and other new findings and highlights new research directions for the neuro-HIV field.