Intranasal Treatment of HIV-associated Neurocognitive Disorders

Inclusion Criteria: * Documented HIV-1 infection * Maintained on stable ART for ≥6 months (defined as undetectable viral load) * HAND-MND or -ANI diagnosis with evidence of clinical onset or progression within the prior 2 years, based on established criteria * Currently followed at the Southern Alberta Clinic (SAC; Calgary, AB, Canada) Exclusion Criteria: * HAND with a) changed dose of any medication for HIV-1 infection with a corresponding increase in viral load (e.g., ART), or b) secondary therapies for HAND (e.g., memantine, amphetamines). * Advanced liver, renal or lung disease, cancer or diabetes requiring insulin * Secondary diagnosis of neurocognitive impairment or other major neuropsychiatric illness such as epilepsy, Alzheimer's or Parkinson's diseases, major depression (PHQ-9 score \>10), or schizophrenia * Central nervous system lesion (diagnosed by neuroimaging) that may impair cognition * Previous allergic reaction to insulin or any of the carrier components. * Education \< 9 years or inability to read and write English fluently * Uncontrolled HIV-1 or hepatitis C co-infection * Inability to perform NP or questionnaire measures, functional illiteracy * Past or current substance abuse that could interfere with the study assessments as determined by the PI * Marijuana use on the day of NP testing * Uncontrolled cardiovascular disease (hypertension, coronary or peripheral artery disease)