HIV infection causes a wide range of central nervous system (CNS) diseases, making it difficult to diagnose brain problems, especially if they are not associated with HIV. The article analyzes confirmed cases of CNS tumors and tumor lesions in HIV-positive patients and focuses on neuroimaging features for differential diagnosis. Multiparametric magnetic resonance imaging (mpMRI) is essential for accurate diagnosis when clinical history or physical examination is limited. Brain pathology is often manifested by reduced consciousness, which can progress to coma. Specific neuroimaging patterns are of practical value to physicians and radiologists. Correct diagnosis of a brain lesion enables the selection of appropriate treatment strategies and reduces mortality.