HIV/AIDS surveillance report : U.S. HIV and AIDS cases reported December 1995
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HIV/AIDS surveillance report : U.S. HIV and AIDS cases reported December 1995

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      Year-end edition, Vol. 10, No. 2.

      During 1998, 48,269 persons were reported with AIDS, more than half (57%) from the states of New York, Florida, New Jersey, California, and Texas. A total of 688,200 persons have been reported with AIDS since the beginning of the epidemic. In 1997, the most recent full year for which estimates of the numbers of persons living with AIDS are available (because of the lag time needed to take reporting delays into account, see technical notes), an estimated 270,841 persons were living with AIDS, a 12% increase from 1996. The number of persons living with AIDS increased as a result of improved survival for AIDS patients who were receiving treatment and substantial decreases in the number of deaths in 1997.

      Between 1992 and 1997, the number of persons living with AIDS increased in all groups, as a result of the 1993 expanded AIDS case definition and more recently, improved survival. The characteristics of persons living with AIDS have changed, reflecting changes in the populations affected by the HIV/AIDS epidemic. Women accounted for 13.8% of persons living with AIDS in 1992, compared with 19.1% in 1997. By the end of 1997, the number of blacks living with AIDS, which increased from 32.7% of persons living with AIDS in 1992 to 39.2% in 1997, was almost identical to the number of whites living with AIDS. Persons living in the South accounted for 33.6% of cases in 1992 and 36.7% in 1997, and persons living in the Northeast accounted for 28.3% in 1992 and 30.3% in 1997; the proportion living in the West declined from 23.8% to 20.4%. The characteristics of persons living with AIDS (sex, age, race/ethnicity) as of the end of 1997 in all states and metropolitan statistical areas were published in a supplemental report in February 1999, the first in a series of reports intended to provide additional data on selected topics. This report can be accessed at stats/hasrsupp.htm.

      In the 33 states and territories that report HIV infection, 19,393 persons with HIV infection but not AIDS were reported during 1998. In addition, 1,871 persons were reported first with HIV and then with AIDS during 1998; for this report these persons are counted only once as AIDS cases. In these same states, a total of 97,962 persons are reported as living with HIV infection (table 1); that is, as of the end of 1998, they are not known to have AIDS or to have died. Because not all HIV-infected persons have been tested, the number of persons reported to be living with HIV represents a minimum estimate of the number of persons living with HIV infection. Differences among states in the relative proportion of prevalent cases reported as HIV compared to AIDS (table 1) are the result of many factors: they may reflect variations in testing patterns, access to care, and survival; differences in the distribution of affected populations in terms of sex, race, and risk; and differences in the stage of the epidemic. In addition, factors related to the implementation of HIV reporting, such as the date of implemen-tation and whether prevalent HIV cases were reportable at implementation, also affect these proportions. For example, the recent implementation of HIV reporting in Florida and New Mexico, initiated in July 1997 and January 1998, respectively, accounts for the low number of persons reported as living with HIV infection compared with the number reported as living with AIDS.

      HIV reporting data are increasingly necessary to monitor the effect of the epidemic because of the therapies that have reduced AIDS incidence. By the end of 1998, 29 states and the Virgin Islands had implemented the confidential name-based reporting of HIV infection in adolescents and adults; three additional states report pediatric HIV infection only. States that have initiated confidential name-based HIV reporting in the past 2 years are Florida, Iowa, New Mexico, and Virgin Islands; Alaska, New York, and Texas are beginning HIV case surveillance in 1999. Although AIDS incidence can no longer provide unbiased information on HIV incidence patterns as it has in the past, because of the effect of potent antiretroviral therapies, the monitoring of AIDS incidence nonetheless remains critical. Persons reported with AIDS increasingly represent persons whose diagnosis was too late for them to benefit from treatments, persons who either did not seek or had no access to care, or persons for whom treatment failed. Monitoring this population remains of the utmost importance, and supplemental studies will be needed to determine the reasons for continued AIDS incidence.


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