ArticleCureus2025
Ethical and Clinical Considerations in the Workup of HIV-Associated Neurocognitive Decline.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Human immunodeficiency virus (HIV) can invade the central nervous system, leading to a spectrum of neurocognitive disorders known as HIV-associated neurocognitive disorder (HAND). Despite the widespread use of combination antiretroviral therapy (cART), patients remain at risk for HAND and other neurologic complications, including progressive multifocal leukoencephalopathy (PML) and HIV encephalitis (HIVE). Differentiating among these conditions is crucial, given their distinct etiologies, prognoses, and management strategies. We describe a 37-year-old man with a six-month history of untreated HIV who presented with a four-week history of progressive cognitive decline, confusion, incontinence, and loss of functional independence. T2/fluid-attenuated inversion recovery (FLAIR) MRI revealed bilateral cerebral white matter hyperintensity with patchy involvement of the cerebellar peduncles, excluding U-fibers and the corpus callosum, raising concern for PML, HIVE, or advanced HAND. His clinical course was complicated by inconsistent treatment adherence, medication refusal, and eventual determination of decision-making incapacity. Family conflict related to stigma rooted in his bisexual identity and HIV status contributed to delays in timely diagnostic testing and transition to hospice care. These delays were partly a result of his decision-making surrogate's difficulty in communicating prompt healthcare decisions due to family discord. This case highlights the dual challenges of clinical ambiguity and ethical conflict in the care of patients with advanced HIV. Diagnostic evaluation of HIV-associated cognitive decline requires integration of neuroimaging, cerebrospinal fluid studies, and neuropsychological testing. However, even when clinical pathways are evident, stigma, fractured family dynamics, and the absence of advance directives can obstruct timely and appropriate care. Optimal management of HIV-associated neurocognitive decline extends beyond biomedical treatment. A stigma-informed, ethically sensitive approach, including early counseling, advance care planning, surrogate support, and ethics consultation, is essential to protect patient autonomy and improve healthcare outcomes. This case emphasizes the need to address psychosocial and ethical barriers alongside clinical management in patients with severe HIV-related neurocognitive impairment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.