A new consensus statement by Sam Nightingale and colleagues proposes a revised approach to classifying cognitive impairment in people living with HIV. While the authors' efforts are commendable, the authors argue that current HIV-associated neurocognitive disorder (HAND) criteria should be updated rather than discarded, to avoid losing historical data. The inclusion of neuroimaging criteria could improve HAND diagnosis, but this requires standardized definitions of 'active' and 'legacy' HIV-associated brain injury (HABI), which are not well defined. The current HAND criteria distinguish HABI from other causes of brain injury by requiring that no other conditions reasonably explain cognitive impairment. However, the authors suggest that this strict dichotomy may not reflect the complexity of lived HIV experiences, where comorbidities interact with HIV. This approach could lead to underestimating the impact of HAND, particularly in marginalized populations. The statement also notes that HIV can remain active in the brain despite effective antiretroviral therapy, which is associated with brain injury. Relying on standard viral suppression in peripheral blood or cerebrospinal fluid may not address the risk for HAND. The authors also highlight the need for better neuropsychological norms and cut-offs for early diagnosis, similar to those used for mild cognitive impairment. They emphasize the importance of improving health literacy and access to care for people living with HIV. The authors welcome further discussion and collaboration with community members to achieve greater consensus in the field. The letter includes a reply by Nightingale and colleagues. The authors are from various institutions around the world and have experience with HIV. They acknowledge the contributions of people with lived HIV experience and community organizations. The authors declare no competing interests.A new consensus statement by Sam Nightingale and colleagues proposes a revised approach to classifying cognitive impairment in people living with HIV. While the authors' efforts are commendable, the authors argue that current HIV-associated neurocognitive disorder (HAND) criteria should be updated rather than discarded, to avoid losing historical data. The inclusion of neuroimaging criteria could improve HAND diagnosis, but this requires standardized definitions of 'active' and 'legacy' HIV-associated brain injury (HABI), which are not well defined. The current HAND criteria distinguish HABI from other causes of brain injury by requiring that no other conditions reasonably explain cognitive impairment. However, the authors suggest that this strict dichotomy may not reflect the complexity of lived HIV experiences, where comorbidities interact with HIV. This approach could lead to underestimating the impact of HAND, particularly in marginalized populations. The statement also notes that HIV can remain active in the brain despite effective antiretroviral therapy, which is associated with brain injury. Relying on standard viral suppression in peripheral blood or cerebrospinal fluid may not address the risk for HAND. The authors also highlight the need for better neuropsychological norms and cut-offs for early diagnosis, similar to those used for mild cognitive impairment. They emphasize the importance of improving health literacy and access to care for people living with HIV. The authors welcome further discussion and collaboration with community members to achieve greater consensus in the field. The letter includes a reply by Nightingale and colleagues. The authors are from various institutions around the world and have experience with HIV. They acknowledge the contributions of people with lived HIV experience and community organizations. The authors declare no competing interests.