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Commentary

The Centers for Disease Control and Prevention (CDC) collects, analyzes, and disseminates surveillance data on HIV infection and AIDS; these data are the nation’s source of information on the HIV epidemic. The annual surveillance report, published by the Division of HIV/AIDS Prevention, summarizes information about HIV infection and AIDS in the United States and 5 U.S. dependent areas (this report, formerly known as the HIV/AIDS Surveillance Report, has been renamed the HIV Surveillance Report). HIV surveillance data are used by CDC’s public health partners in other federal agencies, health departments, nonprofit organizations, academic institutions, and the general public to help target prevention efforts, plan for services, develop policy, and monitor the HIV epidemic. In accord with CDC’s recognition of the changing needs for data and its commitment to meeting those needs, the presentation of 2008 data emphasizes the date of diagnosis of HIV infection or AIDS (diagnosis as of December 31, 2008; reported to CDC as of June 30, 2009). The term HIV/AIDS—previously used to refer to a diagnosis of HIV infection regardless of the person’s AIDS status at the time of diagnosis—has been replaced with the term diagnosis of HIV infection. The new title of the report—HIV Surveillance Report—reflects this change in terminology.

Data on HIV infection in the tables presented in the 2008 report reflect the date of diagnosis of HIV infection, not the date of report to CDC. Historically, the date of report has reflected reporting practices; that is, the information may have been reported months or years after the date of diagnosis. HIV data displayed by year of diagnosis more closely approximate the date of infection and are thus the best marker of trends in the epidemic; however, HIV diagnoses do not necessarily represent new infections: some persons were infected recently, and others were infected at some time in the past. Because of reporting delays, the actual numbers of cases diagnosed in a given year may be higher than the numbers of diagnoses of HIV infection (unweighted) presented in this report for recent years; however the numbers of diagnoses for a calendar year typically stabilize after 2 to 3 years of reporting.

The 2008 HIV Surveillance Report is organized into 4 sections:

  1. Diagnoses of HIV infection and AIDS
  2. Deaths and survival of persons with a diagnosis of HIV infection or AIDS
  3. Persons living with a diagnosis of HIV infection or AIDS
  4. HIV infection and AIDS data, by state and metropolitan statistical area (MSA)

Sections 1–3 (Tables 1a/b18a/b) present trends in numbers (statistically adjusted and unadjusted) and rates (adjusted) of diagnoses of HIV infection and AIDS, deaths of persons with a diagnosis of HIV infection or AIDS, and persons living with a diagnosis of HIV infection or AIDS. Section 4 (Tables 1924) presents trends in numbers (adjusted and unadjusted) and rates (adjusted) of diagnoses of HIV infection and AIDS and persons living with a diagnosis of HIV infection or AIDS, by state and MSA. Numerical rankings, based on rates of diagnoses of HIV infection and AIDS, are provided by MSA. All 50 states, the District of Columbia, and 5 U.S. dependent areas had implemented confidential name-based HIV infection reporting by April 2008. Numbers (unadjusted) of diagnoses of HIV infection are presented (Table 19) for all 56 areas for 2008. These numbers should be viewed as minimums, as they have not been adjusted for reporting delays.

The tables in the 2008 report present data in two formats. Tables in the first format—labeled “a”—exclude data from the dependent areas (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). Tables in the second format—labeled “b”—include data from the dependent areas.

Where indicated, counts of diagnoses and deaths have been statistically adjusted to correct for delays in reporting. Because states implemented confidential name-based reporting at different times, the areas included in estimates (adjusted) of numbers and rates of diagnoses of HIV infection are based on the date of implementation of confidential name-based HIV infection reporting. Although all states had successfully implemented confidential name-based HIV infection reporting by April 2008, a national comparison of HIV infection rates will not be possible until the 2012 HIV Surveillance Report, when all states will have mature HIV reporting systems.

The estimated numbers and rates of diagnoses of HIV infection are based on data from the 42 areas (37 states and 5 U.S. dependent areas) that have had confidential name-based HIV infection reporting for a sufficient length of time (i.e., since at least January 2005) to allow for stabilization of data collection and for adjustment of the data in order to monitor trends. This report marks the first time that HIV diagnosis reports from Connecticut, Kentucky, and New Hampshire have been included in the estimates of diagnoses of HIV infection. According to the number of AIDS diagnoses reported to CDC through 2008, these 37 states represent approximately 68% of AIDS diagnoses in the 50 states and the District of Columbia. From 2005 through 2008, the annual estimated number of diagnoses of HIV infection increased 8% in the 37 states; however, the overall annual estimated rate of diagnosis of HIV infection during this period remained stable. Estimated numbers and rates of diagnoses of HIV infection increased in some subgroups. Increases are likely due to increases in HIV testing because estimates of new infections (incidence) through 2006 do not suggest an increase in recent years. However, it is not possible to rule out an increase in HIV infections because the estimation models include a degree of uncertainty. Updated HIV incidence surveillance data will provide the best indication of changes in trends in new HIV infections. The figure on the cover depicts the estimated rates (per 100,000 population) of diagnoses of HIV infection in 2008, by race/ethnicity and sex, for persons residing in the 37 states with confidential name-based HIV infection reporting since at least January 2005. As shown in the figure, the highest rates of diagnoses of HIV infection were among black/African American males and females residing in the 37 states.

The analyses of AIDS diagnoses were based on data from the 50 states, the District of Columbia, and 5 U.S. dependent areas. For trends in AIDS diagnoses, tables of data for the most recent 4-year period include the cumulative totals through 2008 for all 50 states, the District of Columbia, and 5 U.S. dependent areas.

Highlights of Analyses

All statements in this section are based on estimated data. All rates are per 100,000 population. Our standard for determining trends in numbers and rates is based on an increase or a decrease of 5% or more. Exceptions to this standard were made for populations with small numbers.

Diagnoses of HIV Infection and AIDS

Diagnoses of HIV infection

From 2005 through 2008, the estimated numbers of annual diagnoses of HIV infection in the 37 states with confidential name-based HIV infection reporting increased 8% (Table 1a). However, the estimated rates of annual diagnoses of HIV infection during this period remained stable. In 2008, the estimated rate of diagnoses of HIV infection in the 37 states was 19.4 per 100,000 population.

  • Age group: From 2005 through 2008, the rates remained stable among children (less than 13 years of age) and persons aged 13–14, 30–34, 40–44, 60–64, and 65 years and older. The rate for persons aged 35–39 decreased. The rates for persons aged 15–19, 20–24, 25–29, 45–49, 50–54 and 55–59 increased. In 2008, the largest percentage—14% of all diagnoses— and the highest rate—38.7 per 100,000 population—were those for persons aged 40–44 years.
  • Race/ethnicity: From 2005 through 2008, rates among American Indians/Alaska Natives, Asians, and blacks/African Americans increased (Table 1a). The rates among Native Hawaiians/other Pacific Islanders and persons reporting multiple races decreased. The rate among whites remained stable. Among Hispanics/Latinos, the rate decreased, although the number increased. In 2008, blacks/African Americans accounted for 52% of all diagnoses of HIV infection. The rates by race/ethnicity in 2008 were 73.7 in the black/African American population, 25.0 in the Hispanic/Latino population, 22.8 in the Native Hawaiian/other Pacific Islander population, 14.1 in the population of persons reporting multiple races, 11.9 in the American Indian/Alaska Native population, 8.2 in the white population, and 7.2 in the Asian population (Table 1a).
  • Sex: In 2008, males accounted for 75% of all diagnoses of HIV infection among adults and adolescents. The rate among adult and adolescent males was 35.9, and the rate among females was 11.5. During 2005–2008, the rate among males increased 7%, but the rate among females remained stable (Table 1a).
  • Transmission category: During 2005–2008, the number of annual diagnoses of HIV infection among men who have sex with men (MSM) increased. Among male and female adults and adolescents exposed through heterosexual contact, the numbers of diagnoses increased. Among male and female adult and adolescent injection drug users (IDUs), MSM who were also IDUs, and children, the numbers of diagnoses decreased. In 2008, MSM (54%) and persons exposed through heterosexual contact (32%) accounted for 86% of all diagnoses of HIV infection in the 37 states.

AIDS diagnoses

From 2005 through 2008, the estimated numbers and the estimated rates of annual AIDS diagnoses in the United States remained stable (Table 2a). In 2008, the estimated rate of AIDS diagnoses in the United States was 12.2 per 100,000 population.

  • Age: From 2005 through 2008, the numbers and the rates decreased for persons aged 30–34, 35–39, and 40–44. The numbers and the rates increased among persons aged 20–24, 25–29, 55–59, and 60–64. The rates remained stable for children (less than 13 years old) and persons aged 13–14, 15–19, 45–49, 50–54, and 65 and older. In 2008, the highest rate was that for persons aged 40–44 years: 31.1 per 100,000 population.
  • Race/ethnicity: From 2005 through 2008, the rates among American Indians/Alaska Natives and Asians increased. The rates decreased among Hispanics/Latinos and persons reporting multiple races. The rates remained stable among blacks/African Americans, Native Hawaiians/other Pacific Islanders, and whites. In 2008, the rates were 49.3 in the black/African American population, 15.0 in the Hispanic/Latino population, 11.8 in the Native Hawaiian/other Pacific Islander population, 9.8 in the population of persons reporting multiple races, 8.5 in the American Indian/Alaska Native population, 5.3 in the white population, and 4.0 in the Asian population (Table 2a).
  • Sex: From 2005 through 2008, the rates among adult and adolescent males remained stable; among females, the rates decreased (Table 2a). Adult and adolescent males accounted for 74% of all AIDS diagnoses made during 2008. The rates among adults and adolescents in 2008 were 22.4 among males and 7.5 among females.
  • Transmission category: Among male adults and adolescents, the numbers of annual AIDS diagnoses decreased among IDUs and among MSM who were also IDUs (Table 2a). The numbers among males exposed through male-to-male sexual contact and through heterosexual contact increased. Among female adults and adolescents, the number of AIDS diagnoses among those exposed through heterosexual contact remained stable; the number among those exposed through injection drug use decreased.
  • Region: From 2005 through 2008, the rates decreased in the Northeast, increased in the West, and remained stable in the Midwest and the South.

Deaths

Deaths of persons with a diagnosis of HIV infection

From 2005 through 2007, the estimated number of deaths of persons with a diagnosis of HIV infection in the 37 states with confidential name-based HIV infection reporting increased 17% (Table 11a). The estimated rate of deaths increased 14%, from 6.9 per 100,000 population in 2005 to 7.9 per 100,000 population in 2007. The increase in the estimated number of deaths of persons with a diagnosis of HIV infection may be influenced by significant efforts to improve death reporting. It is not possible, however, to rule out an actual increase in deaths of persons with a diagnosis of HIV infection because the estimation models include a degree of uncertainty. Readers should use caution when interpreting trend data on the estimated number of deaths because the estimates for the most recent year are most subject to uncertainty. Deaths of persons with a diagnosis of HIV infection may be due to any cause (i.e., may or may not be related to HIV infection).

  • Age group: The rates of deaths increased among all age groups, except among children (less than 13 years of age) and persons aged 30–34 and 35–39. The rate decreased among persons aged 30–34. The rates among children and persons aged 35–39 remained stable.
  • Race/ethnicity: The rates of deaths increased among American Indians/Alaska Natives, blacks/African Americans, Hispanics/Latinos, Native Hawaiians/other Pacific Islanders, whites, and persons reporting multiple races. The number of deaths in these populations increased as well. Among Asians, the number of deaths increased; however, the rate of deaths remained stable. In 2007, the highest rate of deaths was that for blacks/African Americans: 31.3 per 100,000 population.
  • Sex and transmission category: The numbers of deaths of males in all transmission categories increased, except for males exposed through injection drug use in which the number of deaths remained stable. Among females, the number of deaths increased among those exposed through heterosexual contact and injection drug use.

Deaths of persons with an AIDS diagnosis

During 2005–2007 in the United States, the annual estimated number of deaths among persons with an AIDS diagnosis increased. The annual estimated rate of deaths per 100,000 population remained stable (Table 12a). The increase in the estimated number of deaths of persons with an AIDS diagnosis may be influenced by significant efforts to improve death reporting. It is not possible, however, to rule out an actual increase in deaths of persons with an AIDS diagnosis because the estimation models include a degree of uncertainty. Readers should use caution when interpreting trend data on the estimated number of deaths because the estimates for the most recent year are most subject to uncertainty. Deaths of persons with an AIDS diagnosis may be due to any cause.

  • Age group: From 2005 through 2007, the rates of deaths increased among persons aged 25–29, 50–54, 55–59, 60–64, and 65 and older. Rates remained stable among children (less than 13 years old) and among persons aged 13–14, 15–19, 20–24, 40–44, and 45–49. Rates decreased among persons aged 30–34 and 35–39. In 2007, the highest rate was that for persons aged 45–49: 15.7 per 100,000 population.
  • Race/ethnicity: The annual rates of deaths increased among American Indians/Alaska Natives and among persons reporting multiple races. Rates remained stable among Asians, blacks/African Americans, Hispanics/Latinos, and whites. The number and the rate decreased among Native Hawaiians/other Pacific Islanders.
  • Sex and transmission category: The number of deaths among adult and adolescent males increased among persons exposed through male-to-male sexual contact and those exposed through heterosexual contact. The number of deaths decreased among IDUs and remained stable among MSM who were also IDUs. Among female adults and adolescents, the number of deaths increased among those exposed through heterosexual contact; among those who were IDUs, the number remained stable. During 2005–2007, the rate among males remained stable, and the rate among females increased.
  • Region: The rates of deaths increased in the Midwest and the South, decreased in the West, and remained stable in the Northeast.

Survival

Survival after a diagnosis of HIV infection

Data from diagnoses of HIV infection made during 2000–2004 in the 37 states with confidential name-based HIV reporting were used to describe persons surviving 12, 24, and 36 months after a diagnosis of HIV infection.

  • Survival increased with the year of diagnosis for diagnoses made during 2000–2004, although year-to-year differences were small (Table 13a).
  • Survival decreased as age at diagnosis increased among persons aged 35 and older at time of diagnosis.
  • Survival was greatest among MSM, female adults and adolescents exposed through heterosexual contact, and children regardless of transmission category. Survival was intermediate among male adults and adolescents exposed through heterosexual contact and among MSM who were also IDUs. Survival was lowest among male and female adults and adolescents who were IDUs.
  • By race/ethnicity, survival was greater among Asians, whites, Hispanics/Latinos, and persons reporting multiple races than among American Indians/Alaska Natives and blacks/African Americans. Data for Native Hawaiians/other Pacific Islanders should be interpreted with caution because the estimated number of persons in this category is small and the data are therefore unstable.

Survival after AIDS diagnosis

Data from AIDS diagnoses made during 2000–2004 in the United States were used to describe persons surviving 12, 24, and 36 months after an AIDS diagnosis.

  • Survival increased with the year of diagnosis for diagnoses made during 2000–2004, although year-to-year differences were small (Table 14a).
  • Survival decreased as age increased, particularly among persons aged 35 and older. Survival was greatest for persons in the age groups 13–14 and 15–19.
  • Survival was greatest among MSM and among children exposed perinatally. Survival was intermediate among male and female adults and adolescents exposed through heterosexual contact, as well as MSM who were also IDUs. Survival was lowest among male and female adults and adolescents who were IDUs.
  • Survival was greater among Asians, Hispanics/Latinos, whites, and persons reporting multiple races than among American Indians/Alaska Natives and blacks/African Americans. Data for Native Hawaiians/other Pacific Islanders should be interpreted with caution because the number of persons in this category is small and the data are therefore unstable.

Persons Living with a Diagnosis of HIV Infection or AIDS (Prevalence)

Persons living with a diagnosis of HIV infection

From 2005 through 2007, the estimated number of persons living with a diagnosis of HIV infection (HIV prevalence) increased steadily in the 37 states with confidential name-based HIV infection reporting (Table 15a). At the end of 2007, an estimated 580,371 persons in these states were living with a diagnosis of HIV infection.

  • By age group, the largest percentage of persons living with a diagnosis of HIV infection were persons aged 40–44 during 2007.
  • By race/ethnicity, the largest percentage of persons living with a diagnosis of HIV infection—48%—were blacks/African Americans. The remaining race/ethnicity percentages were whites, 33% of diagnoses; Hispanics/Latinos, 17%; and less than 1% each, American Indians/Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders, and persons reporting multiple races.
  • By sex, 73% of adults and adolescents living with a diagnosis of HIV infection were male.
  • Among male adults and adolescents living with a diagnosis of HIV infection, 64% had been exposed through male-to-male sexual contact, 16% through injection drug use, 12% through heterosexual contact, and 7% through both male-to-male sexual contact and injection drug use. Among female adults and adolescents living with a diagnosis of HIV infection, 73% had been exposed through heterosexual contact and 26% through injection drug use. Among children living with a diagnosis of HIV infection, 89% had been exposed perinatally.

Prevalence rates of diagnoses of HIV infection

At the end of 2007, in the 37 states with confidential name-based HIV reporting, the estimated prevalence rate of diagnoses of HIV infection was 275.4 per 100,000 population (Table 15a). The estimated rates per 100,000 population were 492.8 among male adults and adolescents, 173.0 among female adults and adolescents, and 23.6 among children (aged less than 13 years at the time of diagnosis). Among all racial/ethnic groups, the highest estimated prevalence rate was that for blacks/African Americans: 967.5 per 100,000 population.

Persons living with an AIDS diagnosis

From 2005 through 2007, the estimated number of persons living with an AIDS diagnosis steadily increased (Table 16a). At the end of 2007, an estimated 459,594 persons in the United States were living with an AIDS diagnosis.

  • By age group, the number was highest among persons aged 45–49, followed by persons aged 40–44. The largest percentage increase in prevalence from 2005 through 2007 was among persons aged 60–64.
  • By race/ethnicity, blacks/African Americans accounted for the largest percentage: 44% of all persons living with an AIDS diagnosis. The remaining race/ethnicity percentages were whites, 35%; Hispanics/Latinos, 19%; Asians, 1%; and less than 1% each, American Indians/Alaska Natives, Native Hawaiians/other Pacific Islanders, and persons reporting multiple races.
  • Of the 350,491 male adults and adolescents living with an AIDS diagnosis in 2007, 62% had been exposed through male-to-male sexual contact, 18% through injection drug use, 11% through heterosexual contact, and 8% through male-to-male sexual contact and injection drug use. Of the 105,260 female adults and adolescents living with an AIDS diagnosis in 2007, 65% had been exposed through heterosexual contact, and 32% had been exposed through injection drug use. Of the 3,842 children living with an AIDS diagnosis, 95% had been exposed perinatally.

Prevalence rates of AIDS diagnoses

At the end of 2007, the prevalence rate of AIDS diagnoses among adults and adolescents in the United States was estimated at 152.5 per 100,000 population (Table 16a). The estimated prevalence rates per 100,000 population were 288.3 for adult and adolescent males, 82.8 for adult and adolescent females, and 7.3 for children (aged less than 13 years at the time of diagnosis). By race/ethnicity, the highest estimated prevalence rate for persons living with an AIDS diagnosis was that for blacks/African Americans: 546.7 per 100,000 population.

Additional Resources

The following were prepared by using HIV surveillance data:

Suggested Readings

CDC. Advancing HIV Prevention: New Strategies for a Changing Epidemic—United States, 2003. MMWR 2003;52(15):329–332.

CDC. Dear colleague letter: CDC recommends that all states and territories adopt confidential name-based surveillance systems to report HIV infections. Published July 5, 2005. Accessed April 29, 2010.

CDC. Epidemiology of HIV/AIDS—United States, 1981–2005. MMWR 2006;55(21):589–592.

CDC. Guidelines for national HIV case surveillance, including monitoring for HIV infection and AIDS. MMWR 1999;48(RR-13):1–31.

CDC. A heightened national response to the HIV/AIDS crisis among African Americans. Revised June 2007. Accessed April 29, 2010.

CDC. HIV prevalence estimates—United States, 2006. MMWR 2008;57(39):1073–1076.

CDC. HIV prevention strategic plan: extended through 2010. Published October 2007. Accessed April 29, 2010.

CDC. Questions and answers: general surveillance report questions. Published November 2009. Accessed March 10, 2010.

CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1–17.

CDC. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR 2008;57(RR-10):1–12.

CDC. Subpopulation estimates from the HIV incidence surveillance system—United States, 2006. MMWR 2008;57(36):985–989.

CDC. Summary of changes to the National HIV Surveillance Report. Published May 2010.

CDC. Twenty-five years of HIV/AIDS—United States, 1981–2006. MMWR 2006;55(21):585–589.

Glynn MK, Lee LM, McKenna MT. The status of national HIV case surveillance, United States 2006. Public Health Rep 2007;122(suppl 1):63–71.

Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300(5):520–529.

 

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