HIV/AIDS Surveillance Report: U.S. HIV and AIDS cases reported through December 1999

Details

• Alternative Title:
  HIV/AIDS Surveillance Report; Year-end Edition, Vol. 11, No. 2: U.S. HIV and AIDS cases reported through December 1999
• 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: As of the end of 1999, a total of 733,374 AIDS cases had been reported to CDC. Of these, 82% were men, 18% were women and 1% were children less than 13 years of age; 43% were in whites, 37% in blacks, 18% in Hispanics, <1% in Asians and Pacific Islanders, and <1% in American Indians and Alaska Natives; and 47% were in men who have sex with men, 25% in injection drug users, 10% in persons infected heterosexually, and 2% in persons infected through blood or blood products. During the 1990s the epidemic shifted steadily toward a growing proportion of AIDS cases in blacks and Hispanics and in women and toward a decreasing proportion in MSM, although this group remains the largest single exposure group (see Tables 23 and 24). Blacks and Hispanics, among whom AIDS rates have been markedly higher than among whites, have been disproportionately affected since the early years of the epidemic. In absolute numbers, blacks have outnumbered whites in new AIDS diagnoses and deaths since 1996 and in the number of persons living with AIDS since 1998. The proportion of women with AIDS increased steadily, reaching 23% in 1999, and the proportion infected heterosexually also increased, surpassing (in 1994) the proportion infected through injection drug use. Midway through the 1990s, effective therapies became available and their effects on decreases in AIDS incidence and in deaths were detected at the population level through surveillance as early as 1996. As deaths have decreased, AIDS prevalence has steadily increased year to year, a trend that will continue as long as the number of persons with a new AIDS diagnosis exceeds the number of persons dying each year.
  
  The steep decline in perinatally acquired AIDS (Cover figure) has been one of the dramatic changes of the 1990s, resulting from the rapid implementation of the use of zidovudine (ZDV) to prevent perinatal transmission. The increased use of ZDV took place after publication of the findings of the AIDS Clinical Trial 076 and of the Public Health Service guidelines on the use of ZDV to reduce HIV transmission. More recently, some of the decline in perinatal AIDS can also be ascribed to improved treatments for HIV-infected children, which delay the onset of AIDS-defining illnesses. The rate of perinatal transmission is expected to continue to decline as a result of more aggressive courses of treatment (e.g., combination therapy) and more use of obstetric procedures, such as elective cesarean section, that reduce transmission.
  
  CDC’s current perinatal prevention initiative is focusing efforts in the states and cities that account for most cases of perinatal transmission. Activities include educating providers about the importance of offering counseling and testing to all pregnant women, intensification of outreach to increase prenatal care among high-risk women, public information campaigns, and examining the feasibility of testing at delivery for women who have had no prenatal care. Pediatric HIV surveillance will play an important role, helping to gauge the extent to which intensified prevention efforts contribute to reduced transmission.
  
  HIV data for states with name-based HIV surveillance systems are presented side by side with AIDS data from all states. The distribution of reported HIV and AIDS cases cannot be compared directly because the HIV tables represent only the states that currently report cases of HIV infection, whereas the AIDS tables represent all states and territories. Differences in the distribution of risk, for example, may reflect differences in the epidemic in states that report HIV and those that do not. Note that new HIV diagnoses and persons living with diagnosed HIV infection do not provide a direct measurement of HIV incidence and HIV prevalence because not all infected persons have received a diagnosis of HIV infection. In addition, HIV surveillance data should be interpreted with knowledge of local practices because the data are influenced by the availability of HIV test facilities and the proportion of HIV-infected persons who seek or who defer testing. Finally, HIV data are affected by whether states report prevalent HIV cases or just new diagnoses when they implement HIV reporting. Persons are counted only once in the HIV/AIDS system, thus persons who are reported as having HIV and AIDS are counted only as AIDS cases.
  
  As of December 1999, in the 34 areas with name-based HIV reporting (including Connecticut and Oregon, where only pediatric cases are reportable), 113,167 persons were reported as living with diagnosed HIV (not AIDS); in 1999, 21,419 HIV cases were reported. Women account for 32% of the cases reported in 1999. Among women, blacks and Hispanics account for 77% of cases; among men, blacks and Hispanics account for 59% of cases. Persons aged 13-24 years account for 15% of reported HIV cases, and women account for 49% of cases in this age group. CDC estimates that in the U.S. approximately two thirds of persons living with HIV and AIDS have been tested confidentially. States with HIV reporting can use this information to approximate their total HIV prevalence.
  
  Although new HIV diagnoses do not represent new infections, they can provide information on trends in HIV incidence in certain subgroups. This is especially true for persons under age 25 at diagnosis (Table 25). Because risk behaviors generally are initiated during the late teens, persons who receive a diagnosis before age 25 are most likely to have been infected recently. Assuming stable screening practices and testing behaviors, trends in that age group indicate whether incidence among persons under age 25 is stable, increasing, or decreasing. Given that a substantial portion of new infections occur in that age group, this information is very useful for understanding the patterns of HIV incidence and for targeting prevention efforts.
  
  Guidelines for the surveillance of HIV and AIDS, published in December 1999, recommend integrated HIV and AIDS surveillance. In addition, both the adult and pediatric HIV case definitions were updated to reflect current diagnostic methods and clinical practice. For adults, the results of tests for detectable viral load were included in the case definition to facilitate the reporting of prevalent cases in areas that are initiating HIV surveillance. The pediatric case definition, expanded to reflect changes in clinical practice, now also incorporates the results of viral load tests.
  
  CDC continues to assist states with the implementation and evaluation of HIV reporting systems and to assist with the interpretation of data as the focus shifts from AIDS to HIV. As more states initiate HIV infection reporting, HIV surveillance increasingly complements AIDS surveillance. The integrated HIV/AIDS surveillance system will provide information on the entire population of persons living with HIV infection who have been tested confidentially. This framework will offer a means of collecting additional data on representative samples of persons; these data in turn, will provide the information required to understand the evolution of the epidemic.
  
  
• 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:
  11
• Issue:
  2
• Citation:
  Suggested Citation: Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1999;11(No. 2):[inclusive page numbers].
• Collection(s):
  Infectious Diseases Stephen B. Thacker CDC Library
• Main Document Checksum:
  urn:sha-512:673064aba0df78972e12fa52181dad2b6f1229ec89da238ce1874dffbfda2175eb4f4029c5d15633da3ca0c4c74cc4e659e78787124f9f2a6ca910b68cc2ce9f
• Download URL:
  https://stacks.cdc.gov/view/cdc/53408/cdc_53408_DS1.pdf
• File Type:
  [PDF - 397.15 KB ]