CROI 2026: Neuro-HIV at the Crossroads of Coinfections, Reservoirs, Antiretroviral Therapy, and Comorbidities.

The 2026 Conference on Retroviruses and Opportunistic Infections (CROI) featured important new and impactful findings relevant to the neurologic HIV (neuro-HIV) field. Reports included new evidence linking herpesvirus coinfections to cognitive heterogeneity; studies on neuroinflammation, neuronal injury, and amyloid-related processes in treated HIV; and studies using advanced technologies to address the HIV-infected cells that persist in the central nervous system during antiretroviral therapy and the mechanisms that may maintain those populations. New therapeutic findings were presented on low-dose hydrocortisone and pregnenolone as potential strategies to improve cognition and reduce inflammatory signaling. Additional studies linked brain health in people with HIV to antiretroviral-associated neuropsychiatric effects and to aging-related comorbidities, including cerebrovascular disease, diabetes, metabolic syndrome, insulin resistance, and metabolic dysfunction-associated steatohepatitis. This review summarizes these findings and highlights new mechanistic and therapeutic directions for the neuro-HIV field.