HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through December 2000

Details

• Alternative Title:
  HIV/AIDS Surveillance Report; Year-end Edition, Vol. 12, No. 2: U.S. HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through December 2000
• 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: In June 1981, the first cases of what is now known as AIDS were reported in the United States. Surveillance was established quickly and surveillance data were used to determine how the disease was transmitted and to make prevention recommendations.
  
  In the 1980s there were rapid increases in the number of AIDS cases and deaths of persons with AIDS. The surveillance case definition was expanded in 1985 in recognition of HIV as the etiologic agent of AIDS, in 1987 to include HIV wasting syndrome and other conditions, and in 1993, in response to the use of CD4+ T-lymphocyte counts in the management of HIV infection. Cases peaked with the 1993 expansion of the case definition and then declined. The most dramatic declines in cases and deaths have been observed since 1996, with the widespread use of potent combination antiretroviral therapy.
  
  As of December 31, 2000, CDC had received reports of 774,467 persons with AIDS in the U.S.; 448,060 (58%) are known to have died. Persons with AIDS are surviving longer, thus, they are contributing to steady increases in the number of persons living with AIDS. Through December 2000 there were 450,151 persons reported to the CDC as living with HIV infection or with AIDS. These reports only include persons diagnosed with HIV infection in States with integrated HIV/AIDS surveillance systems and persons diagnosed with AIDS in all States and Territories. In 1999, CDC estimated that 800,000 to 900,000 persons in the U.S. were living with HIV or AIDS. The difference in these values is due to several factors, including that the reporting of persons diagnosed with HIV infection has not yet been implemented in all States and Territories, anonymous tests are excluded from case reports, and many persons are unaware of their HIV status. The characteristics of persons living with AIDS at the end of 1999 are described in a separate supplemental report (accessible online at http:// www.cdc.gov/hiv/stats/hasrsupp.htm).
  
  Among the 42,156 persons reported with AIDS during 2000, 41,960 (99.5%) were adult/adolescent (<13 years of age); of these, 47% were black non-Hispanic and 19% were Hispanic, 1% were Asian/Pacific Islander and less than 1% were American Indian/Alaska Native. Of the 196 children with AIDS reported in 2000, 65% were black non-Hispanic and 17% were Hispanic. Of the cumulative 774,467 persons ever reported with AIDS in the U.S. through December 2000, 99% were adult/adolescent, 43% were white, 38% were black non-Hispanic, 18% were Hispanic, 1% were Asian/Pacific Islander, and less than 1% were American Indian/Alaska Native.
  
  The predominant mode of HIV exposure among an estimated 31,590 adult/adolescent men with AIDS diagnosed in 1999 was male-to-male sex (53%). The estimated incidence of AIDS has declined each year from 1997 through 1999. The proportion of cases attributed to male-to-male sex was stable during this period (Figure 8). The number of AIDS cases among men exposed through heterosexual contact was lower in 1998 and 1999 than in 1997, but the proportion of cases increased slightly. The predominant mode of exposure among an estimated 10,092 adult/adolescent women with AIDS diagnosed in 1999, was heterosexual contact. The estimated AIDS incidence among women fluctuated slightly and the proportion of cases attributable to heterosexual contact increased (Figure 9). The number and proportion of AIDS cases among women exposed through injecting drug use declined.
  
  In 2000, 196 pediatric AIDS cases were reported; of these, 90% were acquired perinatally (Table 15). The number of estimated pediatric AIDS cases diagnosed each year has declined since 1992 (Figure 10). The decline in pediatric AIDS incidence is associated with the implementation of Public Health Service guidelines for universal counseling and voluntary HIV testing of pregnant women and the use of zidovudine by HIV-infected pregnant women and their newborn infants. In addition, some of the decline may be ascribed to improved treatments that delay the onset of AIDS defining illnesses for HIV-infected children.
  
  Data presented in this report indicate a leveling of the declines in deaths among adults and adolescents with AIDS. Estimated deaths declined 42% from 1996 to 1997, but declined 8% from 1998 to 1999. The smaller declines from 1998 to 1999 varied by race/ ethnicity, and were greatest among whites (15%) and American Indian/Alaska Natives (16%), and lowest among black non-Hispanics (3%) (Table 29). Trends in deaths of persons with AIDS reflect the slowing of the declines in AIDS incidence. Other factors associated with the leveling of deaths might include persistence of late testing behaviors in certain populations, limited access to or use of health care services, and limitations of current therapies in treated populations.
  
  Because successful treatment delays progression of HIV infection to AIDS, AIDS surveillance data alone are now insufficient to monitor trends in HIV incidence, or to meet federal, State, or local data needs for planning and allocating resources for HIV prevention and care programs. The lack of an integrated HIV/ AIDS case surveillance system in all areas continues to limit the ability to monitor and characterize populations affected by the HIV epidemic. As of December 2000, 34 States, the Virgin Islands, and Guam had implemented confidential HIV reporting of adults and adolescents or of children, and reported these cases without personal identifiers to CDC (Table 3). Some other states have implemented alternative forms of HIV reporting (see Technical Notes); the remaining States are considering implementing HIV case reporting.
  
  In 2000, 21,704 newly diagnosed cases of HIV infection (not AIDS) were reported from 36 areas. Of the HIV reports received in 2000, 68% were among adult men, 31% were among adult women, and 1% among children <13 years of age. Recent HIV reports represent a mixture of persons with recent infection and others who may have been infected in the past but only now are being diagnosed. Identifying recent infections to monitor HIV incidence in the population may be feasible. One method, that may be applied in the future, to measure HIV incidence is the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) on serologic specimens from all persons with newly diagnosed HIV infection. This method was recommended during a recently held CDC consultation on estimating incidence of HIV infection in the United States.
  
  Recently reported cases of HIV and of AIDS are likely to be missing data on behavioral risk for HIV exposure. Although such information can be obtained later after public health follow-up, the immediate lack of information on HIV exposure category constrains our ability to accurately characterize affected populations and to plan appropriate prevention activities. Data that have been statistically adjusted to account for delays in reporting and to estimate the HIV exposure category for cases initially reported without HIV behavioral risk data provide more meaningful trend information. Tables 22 and 23 describe estimated numbers and proportions of cumulative and recently diagnosed AIDS cases by race/ethnicity and exposure category for adult men and women. Table 30 describes trends in deaths adjusted for delays in reporting by exposure category for adult men and women, and for children <13 years of age. The cover graphs describe trends in estimated AIDS incidence among adults and adolescents, by sex and exposure category, from 1981 through 1999.
  
  To supplement the behavioral risk information available through case reporting, interviews of infected persons are useful in providing more detailed behavioral data. From behavioral and demographic data collected during interviews, estimates of the proportional distribution of HIV exposure categories can be derived. Currently 16 States are conducting such interviews. Other areas are exploring alternative approaches to improve the completeness and timeliness of reporting of HIV exposure data. Some are conducting public health follow-up of a representative sample of cases, including contacting providers and patients; others are targeting other sources of public health data which may contain information on exposure category (for example, sexually transmitted diseases data bases), to improve their ability to describe local trends in HIV transmission.
  
  
• 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:
  44 pdf pages
• Volume:
  12
• Issue:
  2
• Citation:
  Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2000;12(No. 2):[inclusive page numbers].
• Collection(s):
  Infectious Diseases
• Main Document Checksum:
  urn:sha-512:004ae76774f45c3558cae40146eabf5d47d1c28123caebf8a5f6419739fafe8af3809d120b255ae67ec90c6fb6b808795e4a7a40b9e05ee7c13878facbc337cf
• Download URL:
  https://stacks.cdc.gov/view/cdc/149222/cdc_149222_DS1.pdf
• File Type:
  [PDF - 2.67 MB ]