Language disorders in adults with human immunodeficiency virus

Abstract

It has been documented that the human immunodeficiency virus (HIV) exerts a significant impact on the central nervous system (CNS), even in individuals with undetectable viral loads under combined antiretroviral therapy. Chronic immune activation and the persistence of viral reservoirs promote a sustained inflammatory state, which constitutes a key factor in the development of HIV‑associated neurocognitive disorders (HAND). These disorders encompass a spectrum, ranging from mild deficits to dementia, and affecting cognitive functions such as memory, attention, and, notably, language.Language emerges as an early and sensitive clinical marker of neurocognitive involvement, even in asymptomatic stages or in the presence of mild impairment. This chapter presents a comprehensive review of the linguistic impairments observed within the framework of HAND, addressing multiple levels of language processing. It describes deficits in verbal fluency,particularly in phonological tasks requiring executive control; in semantic memory, characterized by a pattern of preferential access to concrete concepts with low cognitive cost; in narrative organization, with difficulties integrating essential and inferential information; and in pragmatic abilities, including impairments in the interpretation of non‑literal meaningsand conversational coherence. These deficits are often not detected by traditional assessments focused on structural aspects of language, highlighting the need to incorporate diagnostic approaches that include discourse and pragmatic tools. Early identification of these linguistic manifestations is essential for guiding appropriate clinical interventions and contributing to comprehensive and interdisciplinary healthcare.