May 13, 1999
Our nation is facing the most critical and devastating epidemic in recent history. HIV infection and the clinical complications that follow are placing a heavy strain on medical and social services in both the public and private sectors. HIV infection/AIDS is the second leading cause of death among adults ages 25-44.
The total number of infected persons in the United States is estimated to be from 650,000 to 900,000. This is equal to 0.3 percent of the U.S. population or approximately 1 in 300 Americans (all ages). In the United States approximately 1 in 160 males and 1 in 1,000 females of all ages, or approximately 1 in 160 adult and adolescent (ages 13 and over) males and approximately 1 in 800 adult and adolescent females are infected with HIV.
Surveillance for AIDS began in 1981, following recognition of the first cases of unexplained severe immunosuppression and the resulting opportunistic illnesses. The AIDS surveillance case definition for adolescents and adults was expanded in 1985 and again in 1993 to reflect increased knowledge of the natural history of HIV infection and to remain consistent with the clinical management of HIV disease.
- During 1998 the following characteristics of persons reported with AIDS have been observed:
Through December 31, 1998, a cumulative total of 688,200 persons with AIDS had been reported to CDC. The 688,200 cumulative reported AIDS cases included:
A total of 410,800 of the 688,200 persons reported with AIDS have died.
AdvertisementAmong men and women who have been reported with AIDS, three HIV exposure groups continue to account for nearly all cases of AIDS:
- 679,739 adolescents and adults,
- 574,783 men,
- 113,414 women,
- and 8,461 children less than 13 years of age
- men who have sex with men - 48 percent
- injection drug use - 26 percent
- and heterosexual contact, primarily through sexual contact with injecting drug users - 10 percent
Nearly all of the pediatric AIDS cases reported, over 90 percent, resulted from perinatal HIV transmission.
- Until recently, CDC primarily reported trends in the epidemic based on the estimated number of people diagnosed with AIDS each year (AIDS incidence). AIDS incidence provided a reliable picture of trends in the HIV epidemic because researchers could take into account the time between HIV infection and progression to AIDS and estimate where and how many new infections were occurring based on observed cases of disease. But, with recent advances in the treatment of HIV infection that have slowed the progression from HIV infection to AIDS and from AIDS to death, AIDS incidence can no longer be used alone to track the path of the HIV epidemic. While AIDS cases and deaths will provide a valuable measure of groups for whom effective treatment is not available or has not succeeded, these data tell us little about where and how many new infections are occurring -- information critical for addressing the increasing need for prevention and treatment services. To analyze recent trends in the epidemic, CDC must therefore rely on data from the states that have so far integrated HIV and AIDS reporting systems for adults and adolescents.
- CDC recently examined trends in HIV diagnoses reported through the integrated HIV and AIDS reporting systems in 25 states, adjusted for reporting delays. The analysis suggests that contrary to the declining trend in AIDS diagnoses, HIV diagnoses remain relatively stable in these states, with an increasing toll on women and minorities. The data also indicate a continuing toll among young people ages 13-24, with at least 2,000 young people diagnosed with HIV in these states every year.
Many of these new diagnoses are occurring among African Americans, women, and people infected heterosexually, with an increase observed among Hispanics. From January 1994 through June 1997, a total of 72,905 adults and adolescents were diagnosed with HIV or AIDS in these states. Of these, 52,690 (or 72% of the total cases) were initially diagnosed with HIV, compared with 20,215 cases (28%) initially diagnosed with AIDS.
- While these newer data provide a reliable indication of the number and characteristics of individuals who have been diagnosed with HIV in confidential settings, they do not include individuals tested only at anonymous test sites or individuals who have not yet been tested. CDC estimates that two-thirds of people living with HIV infection have already been confidentially tested for HIV and know their status. Studies indicate that a high proportion of high-risk individuals have been tested, and given the increasing benefits of early knowledge of HIV status, it is likely that testing will increase. HIV reporting will therefore become increasingly representative of trends in new infections. As additional states implement HIV reporting, these data will become more representative of national trends in the epidemic.