ASD is a multicenter medical record review surveillance project in selected medical facilities in Atlanta, Dallas, Denver, Detroit, Houston, Los Angeles, New Orleans, New York City, Bayamon (Puerto Rico), San Antonio, and Seattle. Facilities include a variety of public and private providers in inpatient and outpatient facilities, private offices, HMOs, and other settings. HIV-infected persons aged ≥13 years who attend participating clinics are eligible for enrollment in ASD. The methods used in ASD have been previously described (1). The medical records of ASD participants are reviewed for the 12 months before their enrollment date and at subsequent 6-month intervals until death or loss to follow-up. Information collected includes basic demographic data, mode of exposure to HIV, prescription of antiretroviral and other medications, CD4+ T-lymphocyte counts, HIV RNA viral load, complete history of AIDS-defining opportunistic illnesses (OIs), other infections, and other conditions and behaviors of medical importance. The ASD project has been ongoing since 1990; in this report data were limited to patients with time observed in 1999 (n=9,598). Whether a patient was "ever" prescribed a medication or "ever" had a condition is limited to the information in the patients’ medical records at the participating provider facility and for some patients may be limited to time observed in ASD. Information on insurance coverage was restricted to time observed in 1999 and was not applicable to medications "ever" prescribed.

SHDC is a cross-sectional, population-based, medical record abstraction project commenced in 1999 collecting information from the medical records of HIV-infected persons aged ≥13 years in care. A 2-stage sampling design with unequal selection probabilities is used to identify providers of care for HIV-infected patients and select a representative sample of patients in care from those providers. Providers are selected from those reporting HIV and AIDS cases to state and local health departments. Medical records of sampled patients were retrospectively reviewed for calendar year 1998. Three sites drew representative samples and collected data for this report. Site A was representative of a county including a metropolitan area (>500,000 population); Site B was representative of the southeast portion of a state including a major metropolitan area; and Site C was representative of an entire state which contains 3 metropolitan areas. Site A abstracted the medical records of 288 patients, representing 4,358 patients in care; Site B 253 patients, representing 7,304 patients; and Site C 374 patients, representing 8,099 patients in care. Data elements collected included: demographics, mode of HIV exposure, opportunistic illness diagnoses, prescription of antiretroviral therapies and prophylactic medications, other prophylactic practices such as vaccinations and tuberculin skin testing, laboratory markers of HIV infection including CD4+ and viral load, and comorbid conditions such as mental illness and substance use. SHAS is a cross-sectional interview study of persons age ≥18 reported with HIV or AIDS to 12 participating state or local health departments: Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Los Angeles, Michigan, New Jersey, New Mexico, South Carolina, and Washington.

SHAS methods have been previously published (4). Questionnaires are administered in a standardized manner by trained interviewers. Modules include questions on demographics, sexual behavior, drug use, medical and social service information, and use of preventive therapies. Informed consent is obtained prior to interview, and data are stripped of personal identifiers before being sent to CDC. SHAS originated in 1990 and through the end of 1999 over 23,000 interviews have been completed. SHAS data were limited to patient interviews conducted during calendar year 1999 for this report (n=2,287).

MOPTB was a medical record review of a population- based sample of persons newly diagnosed with HIV or AIDS reported to the state or local health department as HIV or AIDS cases in Seattle, Washington; Jersey City, New Jersey; and New Orleans, Louisiana during 1995 through 1997 (n=869). The objective of the study was to examine whether the US Public Health Service guidelines for the prevention of TB among persons with HIV are being implemented. We studied rates of TST and follow up of reactive skin tests among persons newly diagnosed with HIV or AIDS.

Patients were considered eligible for antiretroviral therapy (ART) if they had been previously diagnosed with an AIDS-defining opportunistic illness (OI), CD4+ < 500 cells/µL, or HIV RNA viral load >20 000 copies/ µL by reverse transcriptase polymerase chain reaction (RT-PCR) or >10 000 copies/mL by branched chain deoxyribonucleic acid (bDNA) (2). ART was defined as prescription of any antiretroviral medication (including HAART). HAART was defined as two nucleoside analogue reverse transcriptase inhibitors (zidovudine+ didanosine, zalcitabine or lamivudine or stavudine+ didanosine or lamivudine) plus at least one protease inhibitor (amprenavir, indinavir, nelfinavir, ritonavir, saquinavir) or non-nucleoside analogue reverse transcriptase inhibitor (delavirdine, efavirenz, nevirapine) (2).

Patients were considered eligible for primary Pneumocystis carinii pneumonia (PCP) prophylaxis if they had a history of an AIDS OI or CD4+ <200 cells/µL and had not been previously diagnosed with PCP (1). PCP prophylaxis was defined as any prescribed use of trimethoprim-sulfamethoxazole (TMP-SMZ), dapsone, aerosolized pentamidine, or atovaquone, alone or in combination, prior to or in the absence of PCP diagnosis (3).

Patients were considered eligible for a tuberculin skin test (TST) if they had no prior history of tuberculosis and no prior positive TST as documented in their medical record or indicated by the patient during an interview.

Public insurance was defined as: Medicaid, Medicare, and other public funded insurance in ASD; Medicaid, Medicare, state-funded assistance programs, CHAMPUS, and Veteran’s Administration medical coverage in both SHDC and SHAS. Private insurance was defined as any private insurance (including HMOs) with premiums paid for by an employer or self-paid (including COBRA) in ASD, SHDC and SHAS. No insurance was specifically documented in the medical record for ASD and SHDC or stated in the interview for SHAS.

In this surveillance report, we present observed data from various studies, but do not conduct hypothesis testing or compare proportions among reported groups. Therefore, comments about proportions which are higher or lower than other proportions are not meant to imply statistically significant differences.

References

1. Farizo KM, Buehler JW, Chamberland ME, et al. Spectrum of disease in persons with human immunodeficiency virus infection in the United States. JAMA 1992;267:1798-1805.
2. Centers for Disease Control and Prevention. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. MMWR 1998;47(No. RR-5):42-82. Updated as the living document February 2001 on the HIV/AIDS Treatment web site, www.hivatis.org.
3. Centers for Disease Control and Prevention. USPHS/IDSA guidelines for the prevention of opportunistic infections in persons with human immunodeficiency virus. MMWR 1999, 46(No. RR-10):4-7.
4. Buehler JW, Diaz T, Hersh BS, Chu SY. The supplement to HIV-AIDS surveillance project: An approach for monitoring HIV risk behaviors. Pub Hlth Reports 1996;111(S1):133-137.