Gaps in Testing for HIV in Individuals with Neurological Conditions: Implementation Strategies to Improve HIV Screening and Early Diagnosis.

PURPOSE OF REVIEW: Neurological conditions remain common among people living with HIV (PLWH) and contribute substantially to morbidity and mortality. Neurological presentations represent a critical opportunity to optimize HIV care pathways. However, HIV testing guidance remains limited for common neurological conditions such as ischemic stroke and cognitive impairment. The absence of clear, neurology-specific testing recommendations leads to missed opportunities for early HIV diagnosis and timely treatment.

RECENT FINDINGS: Strengthening diagnostic and laboratory infrastructure, particularly in high-burden and resource-limited settings, is essential to support systematic HIV screening among patients presenting with neurological symptoms. Policy-level interventions are also needed to reduce stigma and improve access to care. These include integrating HIV testing into national and specialty guidelines, developing consent strategies that address the complexities of impaired mental status, training neurologists to recognize HIV-associated neurological presentations, and implementing patient-centered education initiatives. These approaches may support more standardized HIV testing within neurological practice, facilitate earlier diagnosis and treatment initiation, and improve long-term neurological outcomes for PLWH.