Association of HIV infection with dementia and cognitive impairment: A systematic review and meta-analysis

BACKGROUND: With the widespread use of antiretroviral therapy, people living with HIV (PLWH) are experiencing increased life expectancy, accompanied by a growing burden of age-related comorbidities. Cognitive impairment and dementia have been increasingly reported among PLWH; however, epidemiological evidence regarding their association remains inconsistent. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between HIV infection and the risk of dementia and cognitive impairment. METHODS: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 4, 2026 for cohort studies investigating the association between HIV infection and dementia or cognitive impairment. Study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale were independently conducted by two reviewers. Heterogeneity across studies was assessed using Q test and I² statistics. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models as appropriate. Subgroup, sensitivity, and publication bias analyses were performed. RESULTS: A total of 9 articles were eligible for this analysis. The pooled results showed that HIV infection was significantly associated with an increased risk of dementia and cognitive impairment (RR=2.07, 95% CI: 1.35, 3.17). Substantial heterogeneity was observed across studies (I² =93.7%). Subgroup analyses suggested that publication year, baseline immunological status, and age distribution might partially explain the observed heterogeneity. Sensitivity analysis confirmed the robustness of the findings, and no significant publication bias was detected. CONCLUSIONS: This meta-analysis suggests that HIV infection is associated with an increased risk of dementia and cognitive impairment.