HIV and dementia: A South African dilemma


Dementia is a growing public health concern globally. Of particular concern, from a socio-economic perspective, is the cost of caring for people living with dementia. In 2010, it was estimated that the worldwide cost of caring was more than 604 billion USD annually. As the number of people living with dementia increases, so does this cost. However, less is known about the prevalence of dementia in low- and middle-income countries such as South Africa, as well as the unique risk factors for countries such as ours.

Dementia is a non-communicable disease or syndrome, caused by neurodegeneration, that affects memory, language, orientation and executive functions. As a result, behaviour, mood and ability to perform everyday activities are affected. Dementia is not a normal part of ageing.

In South Africa, disorders associated with neurodegeneration such as traumatic brain injury, alcohol dependence and HIV infection are affecting increasing numbers of older adults. There is also a growing burden of disease from non-communicable diseases such as diabetes, heart disease and obesity, as a result of unhealthy lifestyles and diet, all of which contribute to dementia risk.

There is potentially a growing epidemic of dementia in older South Africa, especially among those with HIV infection. The prevalence of HIV-associated neurocognitive dementia is 15 – 30% in untreated people with AIDS. The prevalence in individuals receiving highly active antiretroviral therapy is 10%, however. Adherence to antiretroviral treatment is essential to hold off the advancement of the virus and a cognitive disorder is potentially very disruptive to proper adherence.

It is difficult to quantify the impact of numbers of people with dementia and the age distribution of people living with dementia in the region but given an adult HIV prevalence rate of 19% in South Africa, it is conceivable that many people living with dementia are also living with HIV.

This presents a unique challenge to our health care and social structures, as well as a unique opportunity to respond effectively to one of the most under-publicised public health care challenges of our time.