When to Refer

Patients at risk of neuropsychological impairment should be referred to a specialist service for assessment, even if cognitive difficulties are not evident.1

The guidelines from the New York State Department of Health AIDS Institute2 recommend that patients with HIV-associated dementia (HAD) should be referred for psychiatric consultation to assist in psychopharmacologic treatment and management, when they present with accompanying:

  • depression
  • mania
  • psychosis
  • behavioral disturbance
  • substance use

Due to the risk of drug-drug interactions and toxicity, patients with HAD2 should also be referred for psychiatric consultation when they:

  • require treatment with multiple psychotropic medications
  • are using illicit substances

Patients with signs and symptoms of delirium should be immediately referred to a hospital.


  1. Cysique LA, Murray JM, Dunbar M, Jeyakumar V, Brew BJ. A screening algorithm for HIV-associated neurocognitive disorders. HIV Medicine. 2010; 11: 642–649.
  2. Office of the Medical Director, New York State Department of Health AIDS Institute in collaboration with the Johns Hopkins University Division of Infectious Diseases. Clinical Guidelines: Cognitive Disorders and HIV/AIDS. Accessed 3 March 2011.