Signs and symptoms

Signs and symptoms of HAND experienced by people with HIV that can indicate changes in cognition over time may be a new behaviour (e.g. poorer memory) or may be so subtle that they are missed or people with HIV attribute the changes to something else, such as being tired or busy. If the person has always misplaced keys, this is their usual behaviour. It is more important to take note of new changes in behaviour.

Signs and symptoms of MND and HAND include noting a change in the person’s behaviour and cognition, affecting the person’s ability to perform activities of daily living such as preparing meals, managing finances, remembering doctor’s appointments and driving ability. It may also affect a person’s social relationships and the ability to retain employment or work at a higher level.

The important areas affected are: motor skills, memory, concentration and social engagement. In addition, executive function can also be affected whereby the person may experience changes in their ability to plan, organise and to solve complex or new problems (Table 6).

Table 6: Areas affected by HIV-associated neurocognitive disorder (HAND) and nursing strategies

Area affected

Signs and symptoms


Motor skills

Increasing fatigue

Unsteady gait

Increased clumsiness

Fine motor coordination

Slowed motor speed

Driving deficits

Difficulty typing, texting

Provide information slowly

Give ample opportunity for response

May need assistance to complete activities


Forgetting dates (e.g. birthdays), where placed keys, phone

Memory affecting cooking and shopping

Missing appointments and medications

Forgetting to send emails and issues for meetings

Write down instructions relating to important information and check understanding

Encourage use of memory aids (e.g. diaries, calendars, Post-It notes)

Repeat and write down new information

Provide reminders of appointments

Encourage a routine

Pay more deliberate attention to what the person is trying to remember


How the person becomes receptive to stimuli and how he or she begins to process information Problems include:

Difficulty taking simple information and following directions

Difficulty keeping track of conversations

May have to re-read things

Difficulty completing activities

Difficulty following plots of movies and books

Becoming mentally fatigued easily

Present information in small amounts at a time

Present information in a manner that is clear, simple and concrete

Limit distractions (e.g. TV)

Provide prompts and reorient to task if distracted

Determine the time of day at which the person is most alert and encourage completion of difficult tasks at that point

Behavioural (social) changes

The person can experience one of two areas of behaviour change:

1: Apathy and listlessness


    Lack of motivation

    Impulsivity and disinhibition

2: Hypomania

Change in personality

Increased agitation, aggression, and irritability  (e.g. stealing, swearing,  overfamiliarity)

Emotional lability

Identify the person’s change of mood, ask if he or she is aware of changes; are there any reasons for becoming withdrawn

Arrange a psychiatric assessment to exclude depression

If not depression assist the person to have small achievable goals

Check in with the person frequently to encourage engagement with the service

Identify changes in mood Ask the person what he or she has noticed, whether there are any specific reasons for increased irritability for example

Arrange a psychiatric review ( possible prescription of medications)

Develop strategies to reduce elevated mood or irritability

Refer to other services to support changes in mood outcomes to life

Executive function

The person may experience difficulty in:

Initiation of a task



Cognitive flexibility


Concept formation and abstraction


Feedback utilisation and monitoring behaviour

Encourage client to work through problems with a trusted person and to write down alternative solutions for later referral

Try to break complex tasks down into smaller components

Provide a structure or plan where possible

Guide the client through complex decisions step-by-step

It is important to ask the people with HIV (and a caregiver, if they have one) questions relating to changes either may have noticed. A vital question to start the conversation can simply be:  “Have you noticed any changes?”