The burden of HIV-associated neurocognitive impairment in Australia and its estimates for the future

Abstract

Background The growing number of older individuals with HIV in Australia implies that the prevalence of dementia and additional HIV-associated neurocognitive disorders will increase. There are currently no estimates of the future burden of neurocognitive disease in this population. Methods: We estimated the number and age profile of people living with HIV to the end of 2009 using HIV/AIDS Registry data, and extrapolated these estimates to 2030. Prevalence of HIV-associated dementia (HAD) from 2005 to 2010 from a large Sydney hospital and cost estimates from the AIDS Dementia and HIV Psychiatry Service were used to estimate future HAD burden and costs. Results: Based on our calculations, the number of HIV-positive individuals in Australia will increase from 16 228 men and 1797 women in 2009 to 26 963 men and 5224 women in 2030, while the number of individuals aged 60+ years will increase from 1140 men and 78 women to 5442 men and 721 women, i.e. a 377% increase of older men and an 825% increase in older women. Based on a 7.8% (157/2004) HAD prevalence obtained from hospital data, individuals with HAD will increase in number from 1314 men and 143 women in 2009 to 2204 men and 421 women in 2030. An estimated 22 men and 2 women with non-HIV dementia in 2009 will increase to 104 men and 12 women by 2030. The annual cost of care will increase from ~$29 million in 2009 to $53 million in 2030, mostly for full-time residential care. Conclusions: Neurocognitive disorders will place an increasing burden on resources, especially as those living with HIV age. Because it is unclear if HAD is an increased risk factor for non-HIV dementia, our calculations may be conservative.