HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through December 1996

Details

• Alternative Title:
  HIV/AIDS Surveillance Report; Year-end Edition, Vol. 8, No. 2: U.S. HIV and AIDS cases reported through December 1996
• Corporate Authors:
  Centers for Disease Control and Prevention (CDC) (U.S.) ; National Center for HIV, STD, and TB Prevention. Division of HIV/AIDS Prevention ; Division of HIV/AIDS Prevention. Surveillance Branch. Reporting and Analysis Section ; Division of HIV/AIDS Prevention. Statistics and Data Management Branch
• Description:
  Notice to readers: This issue of the HIV/AIDS Surveillance Report initiates the following additions/changes: (1) Table 12 (year-end edition only) now separates data on AIDS-indicator conditions into (a) those adults/adolescents reported with severe HIV-related immunosuppression as their only AIDS-indicator condition and (b) adults/adolescents reported with other AIDS-defining opportunistic illnesses. The percentages for individual AIDS-defining opportunistic illnesses are based upon the number of adults/adolescents with at least one of the illnesses, rather than upon the total number of reported adult/adolescent cases. (2) Rate calculations for (a) the U.S. Pacific Islands, (b) the Asian/Pacific Islander race/ ethnicity group, and (c) the overall U.S., now include population estimates for the Marshall Islands and the Federated States of Micronesia.
  
  Commentary: Following the first reports of cases of AIDS in 1981, AIDS surveillance has monitored the epidemic in the United States. Through December 31, 1996, 581,429 persons with AIDS were reported to CDC by state and local health departments (tables 1-2). Of these, 488,300 (84 percent) were men, 85,500 (15 percent) were women, and 7,629 (1 percent) were children less than 13 years old (tables 4, 5, and 6).
  
  Persons of black or Hispanic race/ethnicity and women continue to represent increasing proportions of persons reported with AIDS. In 1996, blacks represented 41 percent of adults/adolescents reported with AIDS, exceeding the proportion who are white for the first time (table 10). In 1996, the rates per 100,000 population of reported AIDS cases were 89.7, 41.3, and 13.5 among blacks, Hispanics, and whites respectively. The rates were lowest among American Indians/Alaska Natives (10.7) and Asians/Pacific Islanders (5.9). Rates were lower among adult/adolescent women (12.3) than among men (51.9) (table 10). However, in 1996, women represented 20 percent of adults/adolescents reported with AIDS, greater than the proportion in any previous year.
  
  Although the proportion of adult/adolescent AIDS cases who are men who have sex with men has declined to 50 percent of 54,653 men reported in 1996, men who have sex with men continue to account for the largest proportion of reported cases (table 3). Among women, heterosexual contact and injecting drug use accounted for 40 percent and 34 percent, respectively, of cases reported in 1996 (table 5). However, these proportionate distributions by exposure category will increase over time because a large proportion of cases reported in 1996 (15 percent of men [table 4] and 24 percent of women [table 5]) lack risk information and will be updated as additional review of medical records are conducted (figure 7).
  
  The number of AIDS cases reported during 1996 (69,151) was substantially higher (46 percent) than the number reported during 1992, the year before the expansion of the AIDS surveillance case definition. To identify adults/adolescents who meet the AIDS-defining immunologic criteria that were added to the case definition in 1993, some states expanded their AIDS case finding methods to include laboratory-initiated reporting of severe immunosuppression. The proportion of adult/adolescent AIDS cases reported based on the immunologic criteria increased from 39 percent of 104,616 cases reported in 1993 to 57 percent of 68,473 cases reported in 1996. The expanded definition had a major impact on patterns of case reporting. Therefore, to monitor temporal trends in the occurrence of AIDS-defining opportunistic illnesses, CDC uses statistical methods that take into account the change in the case definition and delays in the reporting of new AIDS diagnoses and deaths among persons with AIDS (tables 18-20 and cover figure). Delays in completing HIV exposure information is accounted for by reclassifying persons with AIDS who were initially reported without a risk to the HIV exposure categories listed in table 3 based on how such persons were reclassified in the past (figure 7).
  
  From 1994 to 1995 (the most recent annual period for which data are available), the estimated incidence of AIDS-opportunistic illnesses increased slightly (approximately 2 percent). This national composite includes trends which vary by region, race/ethnicity, age, and HIV exposure category (tables 18-20). Leveling or declines occurred in some groups (e.g., whites, men who have sex with men, male injecting drug users, and children less than 13 years old) while increases continue to occur in other groups (e.g., blacks, women, and persons infected through heterosexual contact). These variations highlight the complex and diverse characteristics of the epidemic and emphasize the importance of monitoring epidemic trends at the state, local, and national levels and by exposure category, sex, and racial/ethnic group to enhance the relevance of the data for planning and evaluating prevention and care programs.
  
  Since 1981, the AIDS surveillance case definition has been revised in response to improved laboratory and diagnostic methods, increased knowledge of the natural history of HIV disease, and improved clinical management. The case definition, which was based initially on highly specific clinical signs and symptoms of disease, was expanded in 1985, 1987, and 1993 to include additional clinical conditions, HIV antibody test results, and laboratory measures of the effect of the virus on the immune system (CD4+ test results). These revisions to the AIDS surveillance case definition incorporated advances in diagnostic methods and medical practices in order to provide complete, consistent, and reliable information on the numbers of HIV-infected persons with life-threatening opportunistic illnesses (table 12) and deaths among these persons (table 13).
  
  While HIV infection is not reportable uniformly throughout the United States, states that conduct both HIV infection and AIDS case surveillance can estimate the minimum number of persons living with HIV infection or AIDS (table 27). The number of persons who are living with AIDS continues to increase. Through 1996, over 216,000 persons were living with AIDS. However, the cumulative number of persons living with AIDS underrepresents the number of living persons who have been diagnosed with HIV disease because most HIV-infected persons have not yet progressed to AIDS and many persons infected with HIV have not been tested. In 26 states, adults/adolescents who have been diagnosed with HIV infection in private clinical and public HIV counseling and testing settings are reported confidentially. Among these states, the number of reported adults/ adolescents living either with HIV infection or with AIDS as of the end of 1996 (126,491) was 147 percent higher than the number living with AIDS (51,217). However, these data are not adjusted for reporting delays. Using adjustments for delays in reporting of AIDS cases and deaths among these adults/adolescents, the minimum estimate of AIDS prevalence in mid-1996 was approximately 223,000 (see cover figure). This represents a 10 percent increase in AIDS prevalence compared to mid-1995. The increase in AIDS prevalence reflects stable AIDS incidence and declines in AIDS deaths (see MMWR 1997;46:165-73). The increasing prevalence of AIDS provides a minimum measure of the growing need for medical and other services for persons with HIV disease and for prevention programs to reduce the number of persons becoming infected with HIV.
  
  The HIV/AIDS surveillance system must reflect the latest advances in monitoring and treating HIV disease. Improved survival among persons with HIV/AIDS, which is occurring in response to improvements in medical care and increased availability of antiretroviral therapies and prophylaxis for severe opportunistic infections, will affect efforts to monitor the HIV epidemic based on the current AIDS surveillance case definition. In the future, the HIV/ AIDS surveillance system must continue to adapt to changes in the diagnosis and clinical management of HIV disease to ensure that surveillance data are useful for planning and evaluating programs for HIV prevention and care.
  
  
• 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:
  DHP - Division of HIV/AIDS Prevention
• Topic:
  Diseases & Conditions
• Location:
  North America
• Pages in Document:
  40 pdf pages
• Volume:
  8
• Issue:
  2
• Citation:
  Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1996;8(no. 2):[inclusive page numbers].
• Collection(s):
  Infectious Diseases Stephen B. Thacker CDC Library
• Main Document Checksum:
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• Download URL:
  https://stacks.cdc.gov/view/cdc/34401/cdc_34401_DS1.pdf
• File Type:
  [PDF - 748.78 KB ]