The article discusses the need for greater consensus in cognitive criteria for HIV-related cognitive impairment (HAND). While the recent Consensus Statement by Sam Nightingale and colleagues proposes a new approach to classifying HAND, the authors argue that other considerations are necessary to ensure earlier and more consistent diagnosis, prevention, and patient care. They suggest updating the current HAND criteria rather than rejecting them entirely to avoid historical data becoming incomparable. The inclusion of neuroimaging criteria is proposed to improve diagnosis, but the authors note that the concepts of 'active' and 'legacy' HIV-associated brain injury (HABI) are not well defined and would be challenging to implement without advanced resources. The current HAND criteria already distinguish HABI from other causes of brain injury, but the authors argue that this approach may minimize the symptomatology of HAND, especially for individuals from minorities and low-middle-income countries. They also highlight the increasing evidence of persistent HIV activity in the brain despite effective antiretroviral therapy, which poses a significant challenge in curing HIV. The authors emphasize the importance of neuropsychological norms and cut-offs for clinical decision-making and suggest harmonizing HAND definitions with those of mild cognitive impairment. They also point out the common oversight of cognitive impairment and the lack of health literacy and services available to meet the growing demand for care. The article concludes by welcoming further discussion and collaboration with community members to achieve greater consensus and improve health outcomes for people living with HIV.The article discusses the need for greater consensus in cognitive criteria for HIV-related cognitive impairment (HAND). While the recent Consensus Statement by Sam Nightingale and colleagues proposes a new approach to classifying HAND, the authors argue that other considerations are necessary to ensure earlier and more consistent diagnosis, prevention, and patient care. They suggest updating the current HAND criteria rather than rejecting them entirely to avoid historical data becoming incomparable. The inclusion of neuroimaging criteria is proposed to improve diagnosis, but the authors note that the concepts of 'active' and 'legacy' HIV-associated brain injury (HABI) are not well defined and would be challenging to implement without advanced resources. The current HAND criteria already distinguish HABI from other causes of brain injury, but the authors argue that this approach may minimize the symptomatology of HAND, especially for individuals from minorities and low-middle-income countries. They also highlight the increasing evidence of persistent HIV activity in the brain despite effective antiretroviral therapy, which poses a significant challenge in curing HIV. The authors emphasize the importance of neuropsychological norms and cut-offs for clinical decision-making and suggest harmonizing HAND definitions with those of mild cognitive impairment. They also point out the common oversight of cognitive impairment and the lack of health literacy and services available to meet the growing demand for care. The article concludes by welcoming further discussion and collaboration with community members to achieve greater consensus and improve health outcomes for people living with HIV.