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HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through June 2002

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  • Alternative Title:
    HIV/AIDS Surveillance Report; Mid-year Edition, Vol. 12, No. 1: U.S. HIV and AIDS cases reported through June 2000
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  • Description:
    Notice to Readers: This issue of the HIV/AIDS Surveillance Report includes two items that will be discontinued in future issues. Surveillance for HIV/AIDS among health care workers is now conducted by the Hospital Infections Program (HIP) in the National Center for Infectious Diseases. Therefore, Table 17: Health care workers with documented and possible occupationally acquired AIDS/HIV infection will no longer be presented in this report. However, information on occupationally acquired AIDS/HIV infection will continue to be collected and made available by HIP. Inquiries regarding occupationally acquired HIV infection should be directed to the Hospital Infections Program, HIV Infection Branch, 1600 Clifton Road, MS E-68, Atlanta, GA 30333, telephone 404-639-6425. Surveillance methods for identifying the distribution of modes of HIV transmission in the population have evolved from ascertaining risk for all persons reported with a risk to population-based sampling and statistical modeling to estimate risk distributions. Therefore, Figure 6: Results of investigations of adult/adolescent AIDS cases ever classified as risk not reported or identified will no longer be presented. Data in Tables 20–22, 25 and 28 and Figures 9 and 10 present mode of transmission based on statistical estimation procedures. See technical notes.

    Errata: In Volume 11, Number 2 of the HIV/AIDS Surveillance Report, the proportion of cumulative AIDS cases among adult/adolescent men and women was reported incorrectly; the correct proportions are 83% men and 17% women. Table 22 on page 31 reported 176 deaths in children for 1989; the correct number is 371.

    Commentary: The mid-year edition of the HIV/AIDS Surveillance Report presents the first opportunity to examine trends in the estimated incidence of AIDS during 1999 compared to earlier years. Sufficient time has elapsed to allow statistical adjustments for delays in reporting of AIDS cases that were diagnosed during 1999 (Figures 7 - 10). Likewise, trends in estimated deaths among persons with AIDS, and in the prevalence of AIDS, that is the number of persons who are living with AIDS, are presented (Tables 23 - 28). In recent years, marked declines in AIDS incidence and deaths began in 1996 and continued into 1998 in association with the widespread use of potent combination antiretroviral therapies. However, the rates of decline in AIDS incidence and deaths slowed during the latter part of 1998 and 1999. In 1999, the numbers of cases and deaths each quarter have stabilized or are fluctuating slightly in most populations and geographic areas. AIDS prevalence continues to rise with approximately 320,000 persons living with AIDS at the end of 1999, although the rate of increase has slowed.

    There are undoubtedly multiple reasons for these changing trends. These may include: reaching the limits of therapy in extending survival; failing therapies due to treatment-resistant viral strains; late HIV testing; inadequate access to and adherence to treatment in some populations; or recent increases in HIV incidence in some risk groups. Which among these factors contributes to the observed trends cannot be discerned from case reports of AIDS or deaths alone. CDC supports several supplemental surveillance projects that collect data on barriers to preventing AIDS cases and deaths. It appears that each of these factors may be partially contributing to the stalling in trends. To achieve further declines in AIDS incidence and deaths, HIV-infected persons must seek testing earlier in the course of their disease, receive and adhere to treatment, and new HIV infections must be prevented. Figure 11 highlights continued declines in pediatric AIDS incidence, principally among perinatally-acquired infections, as a result of effective perinatal treatment to reduce HIV transmission.

    In addition to trend data, the report presents the activity in reporting AIDS cases and HIV cases (persons diagnosed with HIV infection but who do not have an AIDS diagnosis) to CDC from state and local health departments ( Tables 2-5). The number of reported cases is not only affected by trends in the epidemic but also by artifactual factors that can cause increases or decreases in case-finding independent of underlying trends in HIV incidence. For example, CDC published a revised HIV case definition in December 1999 which includes HIV RNA detection tests (i.e. viral load test results). As states have begun to implement laboratory-initiated reporting of viral load tests, they have identified additional prevalent HIV or AIDS cases. Further, more states are implementing HIV case reporting in response to the changing epidemic and the need for information on persons with HIV infection. As states implement these revised reporting practices, the number of reported cases is likely to fluctuate (Tables 2-4). The identification and reporting of HIV and AIDS cases and deaths is important to enable state and local areas to estimate the minimum size of the population known to be living with HIV/AIDS and to forecast needed resources and services (Table 1).

    Surveillance data provide the scientific underpinning for HIV prevention efforts at the state and local levels. Identifying populations with high risks of exposure to HIV has mostly been based on the demographic and geographic distribution of persons with AIDS, taking into account the percentage of AIDS cases in different exposure categories. In recent years, a growing proportion of AIDS cases, and an even larger proportion of HIV cases, have been reported without HIV risk/exposure data. This reflects the large volume of cases reported, especially in the years after the expansion of the AIDS case definition in 1993, increasing reliance on laboratory-initiated reporting, and growth in the proportion of cases infected as a result of transmission from an infected partner with unrecognized or unreported behavioral risks. During the 1990's, case reporting and follow-up activities of state and local health department surveillance personnel increased dramatically as the epidemic peaked, and resources were not available to obtain complete behavioral risk data on all cases. As a result, it is no longer possible to track trends in HIV exposure categories from case report data alone in most areas.

    To monitor trends by risk/exposure categories, it is now necessary to examine trends using statistical adjustments that take into account how cases initially reported without risk/exposure data are reclassified after follow up with providers or patient interviews. Adjusted trends in estimated AIDS incidence by exposure category are presented in Tables 20 and 21 and Figures 9 and 10 for adult/adolescent men and women, respectively. The basis for these adjustments is shown in Figure 6. CDC and state health departments are adopting new, efficient strategies for obtaining accurate estimates of the distribution of risk/exposures in the population, such as investigating a sample of reported HIV and AIDS cases. In future editions of the Report, Figure 6 will be discontinued and new tables will be added to present adjusted risk/exposure categories for HIV cases, as newer, more representative strategies for risk ascertainment are implemented.

    Because of changes in the epidemic, CDC has advised all states to implement reporting of HIV cases and to integrate HIV/AIDS case surveillance activities to promote efficiency. It is anticipated that all states will be reporting HIV cases to CDC within the next one to two years. Some states are adopting a variety of coded-identifiers for HIV case reporting, necessitating the development of new statistical methods to account for duplicate cases, reporting delays, and incomplete risk/exposure data for these states. During this transition period, CDC will use HIV/AIDS Surveillance Supplemental Reports to present HIV case report data, highlighting methods for analysis and interpretation, and explaining the uses and limitations of these data. CDC and state health departments will also be working together to ensure that supplemental surveillance efforts, such as studies of HIV incidence, surveys in at-risk and infected populations, and investigations of the determinants of the epidemic, are conducted more widely to supplement HIV/AIDS case reporting so as to better inform our understanding of current HIV epidemiology and enhance the effectiveness of public health efforts to prevent and control HIV.

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    Publication date approximated.
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    Centers for Disease Control and Prevention (CDC) (U.S.)
  • Document Type:
    Text
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    United States
  • Rights:
    Public Domain
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  • Pages in Document:
    41 pdf pages
  • Volume:
    12
  • Issue:
    1
  • Citation:
    Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2000;12(No. 1):[inclusive page numbers].
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    urn:sha-512:41c7810003e0f8ea768b83568888271f3b35257a88ef261dc03d61caad5c61f216273d6216dd7eb07f34da7512ab1cea6a028d94a1ee0cbe4d9a516b99f0cf27
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