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Introduction Neurological complications of HIV infection may result from opportunistic infection, neoplasias, and direct effects from the virus. We replicated a 2013 audit of 73 consecutive inpatients demonstrating high burden of neurological disease in adults living with HIV, to compare current prevalence in 2024.Methods Consecutive patients admitted to our tertiary ward underwent assessment. Data collected included history of HIV infection, known neurological disorders, neurological symptoms, and examination findings.Results Fifty one patients (33 male) were assessed over 4 months. Compared to 2013, patients were older (median age 52, range 22-74, vs 44, 25-70), and current CD4 count lower (87.5 cells/μL 6- 953 vs 366, 1-1396). At both timepoints, neurological presentations accounted for 14% admissions (4th commonest reason for admission in 2013, 3rd in 2024). In 2024, 29% had a history of neurological disorders, 31% reported neurological symptoms, and 21% had abnormal signs. Neurological diagnoses necessitating admission include cerebral toxoplasmosis (2, 4%) and progressive multifocal leukoencephalopathy (1, 2%).Conclusion Physicians must remain vigilant to the ongoing high burden of neurological disease in people living with HIV. Neurological liaison services and access to neurological investigations must be included in service development and commissioning plans for care of this population.akiko.fukui1@nhs.net