HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through June 1998

Details

• Alternative Title:
  HIV/AIDS Surveillance Report; Mid-year Edition, Vol. 10, No. 1: U.S. HIV and AIDS cases reported through June 1998
• Corporate Authors:
  Centers for Disease Control and Prevention (CDC) (U.S.) ; National Center for HIV, STD, and TB Prevention. Division of HIV/AIDS Prevention — Surveillance and Epidemiology ; Division of HIV/AIDS Prevention. Surveillance Branch. Reporting and Analysis Section ; Division of HIV/AIDS Prevention. Statistics and Data Management Branch
• Description:
  Commentary: Through June 1998, 665,357 persons with AIDS have been reported to CDC. Continuing the pattern first observed from 1995 to 1996, AIDS incidence decreased again from 1996 to 1997. These decreases are mostly due to the effective therapies for HIV and AIDS that have altered the natural history of HIV infection, and slowed progression to AIDS. AIDS incidence increasingly represents persons who were not diagnosed with HIV infection until they developed AIDS, people who did not access treatment, or people for whom treatment failed. As a result, the ability of AIDS surveillance data to represent the characteristics of affected populations and project the need for prevention and treatment has diminished, and information from HIV infection surveillance in addition to AIDS is becoming increasingly important to monitor the epidemic. For this reason, starting with this edition of the HIV/ AIDS Surveillance Report, information from HIV infection and AIDS case surveillance are presented in an integrated format.
  
  Although the HIV tables and the AIDS tables are now presented side-by-side (e.g., tables 5 and 6), they cannot be directly compared because the HIV tables represent only those states that currently report cases of HIV infection, whereas the AIDS tables represent all states. Differences in distribution of risk, for example, may reflect differences between the epidemics in states that report HIV and those that do not. In addition, HIV surveillance data should be interpreted with knowledge of local practices because they are influenced by the availability of HIV test facilities and the proportion of HIV-infected persons who seek or defer testing. CDC estimates that the majority of infected persons in the United States have been tested. The proportion of infected persons tested is expected to increase and the representativeness of the HIV data will increase accordingly. Persons are counted only once in the HIV/AIDS surveillance system; persons who are reported with HIV and with AIDS are counted only as AIDS cases.
  
  The proportion of cases initially reported without risk information has increased, making it more difficult to interpret the risk information for recently reported cases. To compensate for this, selected tables include an adjustment for unreported risk, referred to in the tables as redistribution of risk. Recent AIDS incidence in some categories, especially heterosexual contact, will be under-estimated unless an adjustment is made. To make the data presented in tables 9, 11, and 13 more readily interpretable, these data are now presented with this adjustment in tables 20, 21, and 22. Because the adjustment is done according to year of diagnosis rather than year of report, tables 20, 21, and 22 represent persons diagnosed from January through December 1997, rather than persons reported from July 1997 through June 1998. Methods to estimate risk among HIV infection cases initially reported without risk are currently being developed. In future editions of the report, corresponding tables for HIV infection cases will be included.
  
  Since 1994, this report has provided estimated trends in AIDS opportunistic illnesses (AIDS-OI) incidence. The procedure to estimate AIDS-OI incidence was developed to take into account the 1993 expansion of the case definition which temporarily distorted the AIDS incidence curve. By 1996 the temporary distortion had almost entirely waned and AIDS-OI incidence was similar to AIDS incidence. In addition, since the end of 1996, the incidence of AIDS-OIs can no longer be reliably estimated because data are not currently available to model the increasing effects of therapy on the rate of disease progression. As a result, this report presents trends in annual AIDS incidence starting in 1996, rather than estimated AIDSOIs. These changes in the method of monitoring trends do not affect pediatric AIDS incidence because the 1993 expansion of the AIDS case definition affected only adult/adolescent cases, not pediatric cases. Figure 11 shows pediatric AIDS incidence from 1992 to 1997.
  
  Comparing AIDS incidence in 1997 to AIDS incidence in 1996 reveals decreases in all groups, with a 15% decrease overall. The decrease is smaller among women (8%) than men (16%). The smallest decreases were observed in the South (12%), among blacks (9%), and among persons infected through heterosexual contact (6% for women and 3% for men). Overall, the decreases are mostly related to use of new therapies, but differences in decreases among groups are principally influenced by the underlying pattern of HIV incidence. The groups that have experienced the greatest increases in AIDS in recent years, as a reflection of increased HIV infection in the preceding years, are those experiencing the smaller decreases in AIDS incidence now. AIDS deaths continue to decline as well, with a 42% decrease between 1996 and 1997. The decreases are greater among men than among women (44% and 32%, respectively), and are greatest in the West (51%), among whites (51%), and among men who have sex with men (49%).
  
  Pediatric AIDS incidence continues to decrease, reflecting the successful implementation of U.S. Public Health Service guidelines for counseling and voluntary testing of pregnant women and for zidovudine use to reduce perinatal transmission. Trends in pediatric AIDS incidence and the impact of the implementation of the guidelines on testing and treatment of pregnant women have been published in recent MMWR articles.
  
  In the 31 states that report cases of HIV infection, 17,311 persons with HIV infection and not AIDS were reported from July 1997 through June 1998. An additional 1,167 persons were reported twice during this 12-month period, first with HIV infection and later with AIDS; however, they are counted only once (as AIDS cases) in this report. Persons 13 to 24 years of age accounted for 15% of persons reported with HIV infection. Women accounted for 32% of all adult cases of HIV infection and for 49% of persons 13 to 24 years of age reported with HIV infection. Among men, blacks and Hispanics accounted for 60% of reported cases and among women, blacks and Hispanics accounted for 78% of reported cases.
  
  As the emphasis of the report shifts, HIV data will be presented in new ways. In addition to estimating risk for those initially reported without risk information, trends in HIV diagnoses will also be presented. State and territorial health departments are placing increasing emphasis on HIV program activities, as well as AIDS, in order to be consistent with current public health recommendations for early voluntary testing, diagnosis, and treatment of HIV-infected persons. This report reflects the evolution of the surveillance system as it works towards meeting public health needs in a changing epidemic.
  
  
• Content Notes:
  Publication date approximated.
• Subjects:
  Acquired Immunodeficiency Syndrome Acquired Immunodeficiency Syndrome / Epidemiology Data Interpretation, Statistical Epidemics Epidemiological Monitoring HIV Public Health Surveillance Statistics Tables
• Keywords:
  DHP_HIV_Reports
• Series:
  HIV Surveillance Report
• Subseries:
  HIVSR
• Publisher:
  Centers for Disease Control and Prevention (CDC) (U.S.)
• Document Type:
  Text
• Genre:
  Statistics ; Report
• Place as Subject:
  United States
• Rights:
  Public Domain
• CIO:
  National Center for HIV, STD, and TB Prevention (NCHSTP)
• Division:
  DHPSE - Division of HIV/AIDS Prevention — Surveillance and Epidemiology
• Topic:
  Diseases & Conditions
• Location:
  North America
• Pages in Document:
  40 pdf pages
• Volume:
  10
• Issue:
  1
• Citation:
  Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1998;10(No. 1):[inclusive page numbers].
• Collection(s):
  Infectious Diseases
• Main Document Checksum:
  urn:sha-512:47dc2ca93880025a9b1706e554d4a9608ad998b5bf9bac561f0c3b337959c59fd9134691560a2088c939287f27f197db22b1e12612bdae5c7e9f4c8a8c8213e4
• Download URL:
  https://stacks.cdc.gov/view/cdc/149069/cdc_149069_DS1.pdf
• File Type:
  [PDF - 1.15 MB ]