The current study examined the effect of the introduction of HAART on survival following AIDS dementia complex (ADC). The researchers examined Australian AIDS notification data pre-HAART (1993-1995) and HAART (1996-2000). They used Kaplan-Meier estimates, with examination of factors influencing survival in a Cox proportional hazards model.

In 1993-2000, 5,017 initial AIDS-defining illnesses were diagnosed among 4,351 AIDS patients. The proportion of AIDS patients with ADC increased from 5.2 percent in 1993-1995 to 6.8 percent in 1996-2000. A total of 254 ADC cases were diagnosed from 1993-2000, and patients with ADC were significantly older than those with non-ADC AIDS. The median CD4 lymphocyte count at ADC diagnosis increased over the study period for those with early HIV diagnosis, but not for patients with late ADC/AIDS diagnosis. Median survival following AIDS diagnosis increased from 19.6 months for 1993-1995 to 39.6 months for 1996-2000. Median survival following ADC diagnosis increased from 11.9 months for 1993-1995 to 48.2 months for 1996-2000. The corresponding increase in median survival for non-ADC AIDS cases was 19.8 to 39.5 months in 1996-2000.

Prior to HAART, the authors pointed out, ADC was shown to be associated with high AIDS mortality. "Survival following ADC was particularly poor when presenting at very advanced immunodeficiency," they wrote. "ADC diagnosed in our study with a CD4 lymphocyte count <100 x 106 cells/l in the 1993-1995 period had a median survival of only 5 months. In contrast, during 1996-2000, ADC with a CD4 lymphocyte count <100 x 106 cells/l had a median survival of 38 months and CD4 lymphocyte count appeared to be a weak survival predictor. This suggests that both commencement of HAART in those with ADC and late HIV diagnosis and alteration of antiretroviral therapy regimens in those with ADC and with prior therapy enable recovery of immune function and protection against other AIDS-related opportunistic disease."

Despite the declining ADC incidence, ADC prevalence appears to have increased in Australia since 1995 -- a trend that is largely the result of greater survival following ADC. This increase in the number of people living with ADC indicates the continuing need for ADC treatment and care services. The current study was not able to assess the level of cognitive impairment among this population.

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