Neurological Manifestations in People Living with Human Immunodeficiency Virus (PLHIV) in India: A Scoping Review and the Need for a National HIV-Neurology Special Interest Group

Abstract

BACKGROUND AND OBJECTIVES: Despite a low national prevalence of 0.20%, India's absolute burden of 2.544 million people living with human immunodeficiency virus (HIV) presents clinicians with varied neurological complications. While combination antiretroviral therapy (ART) has extended survival, the neuro-HIV profile in India, characterized by the predominance of HIV-1 clade C, remains distinct from that reported in Western cohorts. This scoping review aimed to identify patterns of neurological manifestations in India across the pre-ART, ART, and "treat-all" eras and to support the establishment of a National HIV Neurology Special Interest Group. METHODS: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, a systematic search was conducted for studies published between 1991 and 2025. Eligible studies included Indian adults living with HIV aged ≥18 years with definitive neurological syndromic diagnoses. RESULTS: A total of 148 studies involving 3,433 patients were included. The "treat-all" era (post-2017) had the highest reporting volume from India. The central nervous system involvement predominated (94.7%), with opportunistic infections identified as the most common etiology (74.83%). Meningitis was the most-frequent neurological syndrome (1,187 cases; 54.5%), and Cryptococcus (439 cases; 12.78%) and Mycobacterium tuberculosis (374 cases; 10.89%) were the most common pathogens. Diagnoses were commonly established using a combination of clinical examination, neuroimaging, and cerebrospinal fluid analysis (2,799 cases; 81.5%). ART data were unavailable for 91.8% of patients. CONCLUSIONS: The neurology-HIV scenario in India is characterized by a high burden of acute opportunistic infections. The significant dependence on empirical polypharmacy and the identified gaps in ART-related data reveal a poorly integrated care model.