HIV-associated neurocognitive disorders (HAND) persist despite the use of potent antiretroviral therapy (ART). A study of 1,555 HIV-infected adults found that 52% had neuropsychological impairment, with higher rates in those with greater comorbidity. Specific HAND diagnoses included 33% asymptomatic neurocognitive impairment, 12% mild neurocognitive disorder, and 2% HIV-associated dementia (HAD). Participants with minimal comorbidities had lower impairment rates when viral loads were suppressed and CD4 counts were above 200 cells/mm³. While HAD was rare, milder forms of impairment remained common. The study suggests that early disease events, such as severe CD4 decline, may contribute to chronic CNS changes, and that early ART may prevent or reverse these changes. The findings highlight the need for further research to understand the relationship between ART, disease progression, and neurocognitive outcomes. The study also emphasizes the importance of accurate diagnosis and classification of HAND, as well as the impact of comorbid conditions on neurocognitive impairment. The results indicate that even with effective ART, some individuals may still experience neurocognitive impairment, underscoring the need for ongoing monitoring and intervention. The study was conducted by the CHARTER group, which included researchers from multiple universities and institutions. The study's findings have implications for the management of HIV and the development of strategies to improve neurocognitive outcomes in HIV-infected individuals.HIV-associated neurocognitive disorders (HAND) persist despite the use of potent antiretroviral therapy (ART). A study of 1,555 HIV-infected adults found that 52% had neuropsychological impairment, with higher rates in those with greater comorbidity. Specific HAND diagnoses included 33% asymptomatic neurocognitive impairment, 12% mild neurocognitive disorder, and 2% HIV-associated dementia (HAD). Participants with minimal comorbidities had lower impairment rates when viral loads were suppressed and CD4 counts were above 200 cells/mm³. While HAD was rare, milder forms of impairment remained common. The study suggests that early disease events, such as severe CD4 decline, may contribute to chronic CNS changes, and that early ART may prevent or reverse these changes. The findings highlight the need for further research to understand the relationship between ART, disease progression, and neurocognitive outcomes. The study also emphasizes the importance of accurate diagnosis and classification of HAND, as well as the impact of comorbid conditions on neurocognitive impairment. The results indicate that even with effective ART, some individuals may still experience neurocognitive impairment, underscoring the need for ongoing monitoring and intervention. The study was conducted by the CHARTER group, which included researchers from multiple universities and institutions. The study's findings have implications for the management of HIV and the development of strategies to improve neurocognitive outcomes in HIV-infected individuals.