Major or Mild Neurocognitive Disorder Due to HIV Infection 633
Associated Features Supporting Diagnosis
Major or mild NCD due to HIV infection is usually more prevalent in individuals with
prior episodes of severe immunosuppression, high viral loads in the cerebrospinal fluid,
and indicators of advanced HIV disease such as anemia and hypoalbuminemia. Individ-
uals with advanced NCD may experience prom inent neuromotor features such as severe
incoordination, ataxia, and moto r slowing. There may be loss of emotional control, includ-
ing aggressive or inappropriate affect or apathy. 
Prevalence
Depending on stage of HIV disease, approx imately one-third to over one-half of HIV-
infected individuals have at least mild neuroc ognitive disturbance, but some of these dis-
turbances may not meet the full criteria for mild NCD. An estimated 25% of individuals
with HIV will have signs and symptoms that meet criteria for mild NCD, and in fewer than
5% would criteria for major NCD be met. 
Development and Course 
An NCD due to HIV infection can resolve, improve, slowly worsen, or have a fluctuating
course. Rapid progression to profound neur ocognitive impairment is uncommon in the
context of currently available combination antiviral treatment; co nsequently, an abrupt
change in mental status in an individual with HIV may prompt an evaluation of other
medical sources for the cognitive change, incl uding secondary infections. Because HIV in-
fection preferentially affects subcortical regi ons over the course of  illness, including deep
white matter, the progression of the disorder follows a “subcortical ” pattern. Since HIV
can affect a variety of brain regions, and the illness can take on many different trajectories