Neurological manifestations in people with HIV in HAART era: a cross-sectional multicenter study

Background The landscape of neurological manifestations of HIV remains unknown after HAART is applied. This study aimed to characterize the spectrum of neurological disorders in people with HIV. Methods This cross-sectional study was conducted in four tertiary hospitals in China, between January 2018, and June 2025. We recruited individuals aged >16 years with HIV who presented with neurological symptoms or had related complaints. The diagnostic criteria for HIV and its stage classification were based on the 2024 Chinese HIV Prevention and Treatment Guidelines as Stage I (Early infection Stage), II (Asymptomatic Stage), and III (AIDS Stage). Data were extracted using standardized forms. Statistical analyses included ANOVA and Chi-square tests, and Fisher’s exact test. Results Three hundred and forty-seven individuals were enrolled, of whom 69% were newly diagnosed with HIV. The most common neurological complaints were headache (30%), dizziness (13%), and neurobehavioral manifestations (8.0%). The most frequent discharge diagnoses were intracranial infections (21%), followed by cerebrovascular disease (16%) and primary headache (11%). Virus (25%), Tuberculosis (20%) and Treponema pallidum (10%) were the three most common types of infections. Few differences were observed among the three HIV stages, except for intracranial infection ( p = 8.09e-06), intracranial space-occupying lesions of unknown cause ( p = 0.03), and anxiety ( p = 0.01). At discharge, cognitive decline was observed in 15%, and dementia was diagnosed in an additional 2%. Conclusion The study emphasizes the importance of HIV testing in the neurological setting. Neurological manifestations could be the first manifestations in people with HIV in HAART era. Intracranial infections were the most common diagnosis.