Attention-deficit/hyperactivity disorder, autism spectrum disorder, and HIV: implications for risk, outcomes, and care for neurodivergent people.

Abstract

Neurodivergence, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), is increasingly recognized as an important factor influencing health across the lifespan. Although ASD and ADHD are diagnosed categorically using standardized criteria based on the Diagnostic and Statistical Manual of Mental Disorders, the traits that define these conditions exist dimensionally across the population and are expressed with wide variability in support needs. Global ASD prevalence is approximately 1% to 2%, and emerging data suggest higher rates of autistic traits among some populations affected by HIV; however, estimates vary substantially based on methodology and diagnostic approach. ADHD affects approximately 2.5% of adults worldwide, although adult prevalence in people with HIV is not well characterized and likely underrecognized. Neurodevelopmental differences in executive function, reward processing, sensory regulation, and social communication may influence HIV acquisition risk, engagement in care, and long-term outcomes. Health care systems designed primarily for neurotypical individuals may inadvertently create barriers for neurodivergent patients. This review outlines a conceptual framework for understanding neurodivergence in the context of HIV, summarizes available epidemiologic and outcomes data, and provides practical strategies for delivering neurodiversity- affirming, accessible care.