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

Details

• Alternative Title:
  HIV/AIDS Surveillance Report; Year-end Edition, Vol. 10, No. 2: U.S. HIV and AIDS cases reported through December 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: 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 http://www.cdc.gov/nchstp/hiv_aids/ 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 implementation 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.
  
  Historically, AIDS incidence data have served as the basis for assessing needs for prevention and treatment programs. Because of the effect of treatment on AIDS incidence, incidence is no longer the most appropriate means of describing the needs of different populations, as areas that are providing care effectively would seem to need fewer resources. AIDS prevalence, rather than AIDS incidence, provides a more accurate measure of the number of persons who require treatment resources because it reflects the total number of persons living with AIDS. AIDS prevalence too, however, will increasingly underestimate the number of persons in care. Because AIDS will not develop in a growing number of HIV-infected persons as they benefit from new therapies, all states should conduct surveillance for persons with a diagnosis of HIV infection as well as those with a diagnosis of AIDS. However, until such data are available, AIDS prevalence will remain the best measure of the impact of the epidemic, and the most accurate, equitable means of estimating the need for patient services.
  
  The effect of treatment on AIDS incidence and the shift in emphasis from AIDS to HIV require new ways of thinking about surveillance data. With respect to AIDS data, year-to-year changes reflect differences in the historic pattern of HIV infection and differences in access to, and utilization of, care; comparisons among groups must take both these factors into account. With respect to HIV surveillance data, reports of diagnosis of HIV infection bear little relationship to the actual time of infection, with the exception of young persons or persons for whom a proxy measure of recency of infection, such as a high CD4+T-lymphocyte count, is available. Information such as CD4+ T-lymphocyte count at the initial diagnosis of HIV infection on a representative sample of persons can be used to estimate the proportion of new HIV diagnoses that represent recent HIV infections. Until such information is available, the number and characteristics of persons living with diagnosed HIV infection and those living with AIDS will be helpful in planning for prevention, treatment, and other services needed to further reduce transmission and to improve survival and quality of life for infected persons.
  
  The dramatic decreases in pediatric AIDS clearly demonstrate that the Public Health Service guidelines for zidovudine use during pregnancy and for the counseling and testing of pregnant women have been implemented and are decreasing the perinatal transmission of HIV. States that report pediatric exposure and HIV infection have been especially effective in monitoring the reasons for decreases in perinatal transmission. The swiftness of the decline has suggested that the goal of eliminating perinatal transmission of HIV may be attainable. Pediatric HIV and AIDS surveillance will play an increasingly important role in identifying populations of women in need of outreach and thus ensuring access to testing and treatment services for these women as well as to ensure that their infants will be healthy.
  
  The next few years will represent a time of transition for HIV/AIDS surveillance. AIDS incidence will continue to be affected by therapy, but the full effect of new therapies on AIDS incidence is not yet known. At the same time, HIV surveillance is gradually being implemented by an increasing number of states. During this transition, the data on prevalence will probably be more useful than data on incidence for public health planning purposes while incidence data will probably be more useful in identifying populations that may require outreach to improve timely access to testing and treatment. To accurately describe affected populations, CDC plans to work closely with state surveillance programs and with the many users of the surveillance data to provide technical assistance in interpreting the data during this time of transition.
  
  
• 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:
  43 pdf pages
• Volume:
  10
• Issue:
  2
• Citation:
  Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1998;10(No. 2):[inclusive page numbers].
• Collection(s):
  Infectious Diseases Stephen B. Thacker CDC Library
• Main Document Checksum:
  urn:sha-512:2daf2934974b86591d17a96a230e0d94c73d54dcfd835a1daac15a919fa0317a07c3d6b4531870e8fda00c415190478569a1fb96e7d15cc602047426676cc537
• Download URL:
  https://stacks.cdc.gov/view/cdc/35001/cdc_35001_DS1.pdf
• File Type:
  [PDF - 333.90 KB ]