SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neuroinfectious Diseases
Implications and Prospects of Immunological and Neuroimaging Research in HIV-Associated Neurocognitive Disorders (HAND)
Xingyuan Jiang 1,2
Chuanke Hou 3
Juming Ma 3
Jiaojiao Liu 4
Wei Wang 5
Xire Aili 6
Qianru Wang 5
Xu Fan 5
Haixia Luo 7
Yanbin Shi 8
Lingling Zhao 9
Hongjun Li 10
1. Henan Clinical Research Center of Infectious Diseases (AIDS)（Affiliated Infectious Diseases Hospital of Zhengzhou University, Henan Infectious Diseases Hospital）, Henan, China
2. Department of Radiology, Beijing Tiantan Hospital, Beijing, China
3. Department of Radiology, Qilu Hosipital of Shandong University, Jinan, China
4. Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
5. Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China, Beijing, China
6. Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
7. Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
8. Medical Imaging Department of Henan Infectious Disease Hospital, Henan, China, Henan, China
9. Medical Imaging Department of Henan Infectious Disease Hospital, Henan, China
10. epartment of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
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Abstract
Combination antiretroviral therapy has achieved success in controlling viral replication in HIV-infected individuals. However, cognitive and motor impairments, affecting 30-60% of patients, persist due to factors like viral escape, immune reconstitution, inflammation, metabolic dysregulation, and drug neurotoxicity. These issues culminate in HIV-associated neurocognitive disorders (HAND), posing a significant global challenge. The current approach to assess cognitive function relies on the Frascati criteria, but it is limited by the need for specialized facilities, time consumption, and insensitivity to early-stage patients. Immunology underpins HAND pathophysiology, and while immunological markers offer insights at the molecular level, they do not provide visual representation or predict neural structural changes. Neuroimaging complements immunology by enabling the observation of neural lesions in HAND from macroscopic and anatomical perspectives. Combining abnormal neuroimaging with immunological biomarkers shows promise in earlier HAND detection compared to cognitive assessments and clinical symptoms. In this review, we performed a literature search on PubMed and Web of Science for articles published between 1990 and 2024 using the keywords such as "HIV-associated neurocognitive disorders," "HIV," "immunity," "neuroimaging," and "treatment." The reference lists of retrieved articles were also manually reviewed to identify additional pertinent publications. We discuss the current epidemiology, diagnostic methods, and neuroimmune mechanisms underlying HIV-associated neurocognitive disorders (HAND). It summarizes current imaging techniques and associated markers, highlighting efforts to integrate neuroimaging and immunology. Additionally, the review explores novel approaches to HAND treatment and its significance in the context of potentially eradicating HIV. We illuminate the systemic links between early HAND diagnosis and the synergy between neuroimaging and immunology, as well as identify candidate biomarkers in HAND pathogenesis.
Summary
Keywords
biomarkers, Hand, HIV, Immunity, Neuroimaging
Received
30 September 2025
Accepted
10 February 2026
Copyright
© 2026 Jiang, Hou, Ma, Liu, Wang, Aili, Wang, Fan, Luo, Shi, Zhao and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yanbin Shi; Lingling Zhao; Hongjun Li
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.