HIV Surveillance -- United States, 1981-2008
June 3, 2011
Within 1 year of the initial report in 1981 of a deadly new disease that occurred predominantly in previously healthy persons and was manifested by Pneumocystis carinii pneumonia and Kaposi's sarcoma, the disease had a name: acquired immune deficiency syndrome (AIDS). Within 2 years, the causative agent had been identified: human immunodeficiency virus (HIV). On the 30th anniversary of the epidemic, to characterize trends in HIV infection and AIDS in the United States during 1981-2008, CDC analyzed data from the National HIV Surveillance System. This report summarizes the results of that analysis, which indicated that, in the first 14 years, sharp increases were reported in the number of new AIDS diagnoses and deaths among persons aged ≥13 years, reaching highs of 75,457 in 1992 and 50,628 in 1995, respectively. With introduction of highly active antiretroviral therapy, AIDS diagnoses and deaths declined substantially from 1995 to 1998 and remained stable from 1999 to 2008 at an average of 38,279 AIDS diagnoses and 17,489 deaths per year, respectively. Despite the decline in AIDS cases and deaths, at the end of 2008 an estimated 1,178,350 persons were living with HIV, including 236,400 (20.1%) whose infection was undiagnosed. These findings underscore the importance of the National HIV/AIDS Strategy focus on reducing HIV risk behaviors, increasing opportunities for routine testing, and enhancing use of care.1
HIV infection is notifiable in all 50 states and the District of Columbia (DC); AIDS is now notifiable as stage 3 HIV infection. For this report, AIDS data reported to CDC by the end of June 2010 from 50 states and DC were analyzed to determine the annual number of AIDS diagnoses, deaths among persons with AIDS, and persons living with AIDS from 1981 through 2008. Surveillance data were adjusted for reporting delays and missing risk-factor information, but not for incomplete reporting.2 Additionally, by using 1) HIV and AIDS data for persons aged ≥13 years at diagnosis from 40 states that have had confidential name-based HIV infection reporting since at least January 2006 and 2) AIDS data from 11 areas, CDC estimated the annual number of persons living with HIV infection using extended back-calculation.3 The estimated number of undiagnosed HIV infections was calculated by subtracting the number of diagnosed infections from the estimated overall HIV prevalence. HIV prevalence rates per 100,000 population were calculated for 2008 based on postcensal estimates from the U.S. Census Bureau.
From 1981 to 1992, the estimated annual number of persons aged ≥13 years with newly diagnosed AIDS grew rapidly, from 318 to 75,457. From 1981 to 1995, the estimated annual number of deaths among persons with AIDS increased from 451 to 50,628 (Figure). These increases were followed by declines of 45% in AIDS diagnoses, from 1993 (75,263) to 1998 (41,462) and 63% in deaths, from 1995 (50,628) to 1998 (18,851). The declines began to level off in 1999, and AIDS diagnoses and deaths remained fairly stable at an average of 38,279 AIDS diagnoses and 17,489 deaths per year during 1999-2008. As a result, the estimated number of persons aged ≥13 years living with AIDS more than doubled from 1996 (219,318) to 2008 (479,161) (Figure).
At the end of 2008, an estimated 1,178,350 persons aged ≥13 years were living with HIV infection, including 236,400 (20.1%) whose infections had not been diagnosed (Table). Most (75.0%) persons living with HIV were male, and 65.7% of the males were men who have sex with men (MSM). HIV prevalence rates among blacks or African Americans (1,819.0 per 100,000 population) and Hispanics or Latinos (592.9) were approximately eight times and two and a half times the rate among whites (238.4) (Table). Greater percentages of those living with HIV infection had undiagnosed HIV among persons aged 13-24 years (58.9%) and 25-34 years (31.5%) than among those aged 34-44 years (18.0%), 45-54 years (13.8%), 55-64 years (11.9%), and ≥65 years (10.7%). Greater percentages of undiagnosed HIV also were observed among males with high-risk heterosexual contact (25.0%) and MSM (22.1%) than among those in other transmission categories. Greater percentages of undiagnosed HIV also were observed among Asians or Pacific Islanders (26.0%), and American Indians or Alaska Natives (25.0%), than among blacks or African Americans (21.4%), whites (18.5%), and Hispanic or Latinos (18.9%) (Table).
Reported by: Lucia Torian, Ph.D., New York City Dept of Health and Mental Hygiene. Mi Chen, M.S., Philip Rhodes, Ph.D., H. Irene Hall, Ph.D., Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Mi Chen, CDC, email@example.com, 404-639-8336.
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication Morbidity and Mortality Weekly Report. Visit the CDC's website to find out more about their activities, publications and services.
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