The promise of antiretroviral therapy transforming HIV into a manageable chronic condition faces an unexpected challenge: cognitive impairment persists in many patients despite viral suppression. This reality forces a reckoning with the assumption that effective HIV treatment automatically preserves brain function throughout aging. A WHO-commissioned systematic analysis examined whether additional interventions beyond standard antiretroviral protocols could protect cognitive health in HIV patients. The review analyzed pharmacological and behavioral strategies designed to prevent mild cognitive impairment and dementia in people already receiving effective viral suppression therapy. The findings reveal a concerning gap between HIV treatment success and cognitive preservation, highlighting that viral control alone may not safeguard long-term brain health. This systematic evaluation represents the most comprehensive assessment to date of supplementary cognitive protection strategies for the HIV population. The research addresses a critical blind spot in HIV care as the first generation of patients on modern antiretroviral therapy enters older age ranges where cognitive decline typically emerges. Understanding which interventions actually work becomes essential as HIV transforms from a fatal diagnosis to a chronic condition requiring decades of neurological health maintenance. The WHO endorsement signals growing recognition that cognitive health deserves equal priority with viral suppression in HIV treatment protocols. These findings will likely influence clinical guidelines for the estimated 39 million people living with HIV globally, particularly as this population ages and faces compound risks from both HIV-related neuroinflammation and normal age-related cognitive changes.