Purpose of Review <p>Neurodevelopmental delays and neuroimaging abnormalities continue to be found in children, adolescents, and youth living with HIV despite the administration of effective combination antiretroviral therapy (cART). However, there are no clear criteria for the diagnosis of HIV-related cognitive impairment in the paediatric cohort as there are for HIV-associated cognitive disorders (HAND) in adults. Neuroimaging could be a useful tool for assessing the extent of HIV-related effects on the brain, but it is not clear how subtle deficits seen on neuroimaging are related to cognitive performance in children, adolescents and youth.</p> Recent Findings <p>We identified 33 studies investigating relationships between cognitive outcomes assessed by cognitive testing and brain changes measured with neuroimaging. Frequently used imaging techniques were structural MRI (sMRI) and diffusion tensor imaging (DTI), while cognitive tests primarily assessed attention, executive function, and general intelligence. Due to methodological heterogeneity, meta-analyses were not performed.</p> Summary <p>Key findings indicate that perinatal HIV may alter brain volumes and white matter integrity, leading to deficits in memory and problem-solving. Most studies were cross-sectional (91%) and had small sample sizes (82% included fewer than 80 subjects), and few utilized qualitative neuroimaging analyses (9%). Neuroimaging has the potential to provide insights into cognitive function in paediatric HIV, yet further research using integrated imaging techniques is needed to clarify underlying neural mechanisms and improve intervention strategies.</p>