Highly active antiretroviral therapy (HAART) has been primarily responsible for declines in AIDS diagnoses and in deaths among persons with AIDS and consequently for increases in the number of persons living with AIDS (1). Effective treatments help persons with AIDS to survive longer and HIV-infected persons to survive longer free of AIDS. Consequently, the use of HAART has led to changes in the age distribution for persons newly diagnosed with AIDS, persons dying of AIDS, and persons living with AIDS. New AIDS cases represent previously untested persons, persons with a prior HIV diagnosis who never entered care, or HIV-infected persons for whom treatment failed. The CDC prevention strategy, Serostatus Approach to Fighting the Epidemic (SAFE), in addition to encouraging counseling and testing for persons at high risk for HIV infection, encourages programmatic activities that link recently diagnosed HIV-infected persons to care and implementation of prevention services to facilitate the adoption of less risky behavior in the HIV-infected (2). This report provides information on new AIDS diagnoses and deaths, and persons living with AIDS with detailed age categories to help guide prevention activities, plan services, and aid in the development of age-appropriate prevention materials.

This report characterizes the following three AIDS events in adolescents and adults in the United States from 1994 to 2000 by years of age: AIDS diagnoses, deaths in persons with AIDS, and persons living with AIDS. For each of these events, the value of the age variable is defined as follows: AIDS diagnoses are years of age at diagnosis; deaths among persons with AIDS are years of age at death; and persons living with AIDS are years of age as of December 31 of the identified calendar year.

Presentation of data in this report

• For each of the three events, a total of seven tables are presented. For AIDS diagnoses, the first table presents the median, the 25th percentile, and the 75th percentile for the years of age at diagnosis from 1994 to 2000. The next two tables present for 1994 to 2000 the number of AIDS cases and the rate per 100,000 population by calendar year and age at diagnosis. The next two tables present by sex, the number of cases and the rate per 100,000 population by year and age at diagnosis. The last two tables present the number of AIDS cases in 2000, one by age at diagnosis and race/ethnicity and the other by sex, age at diagnosis and exposure category. In a similar fashion, deaths among persons with AIDS and persons living with AIDS are summarized.
• Analyses were restricted to the 50 states and the District of Columbia.
• Data by year of diagnosis, year of death, and calendar year are adjusted for delays in reporting and thus are estimated rather than directly reported case counts.
• For the first time in the HIV/AIDS surveillance and supplemental surveillance report series, case rates are calculated using as the numerator the number of cases diagnosed in the year, with adjustments for reporting delays, rather than the number of cases reported in the year. Similarly, deaths rates are calculated using as the numerator the number of deaths among persons with AIDS occurring in the year, with adjustments for reporting delays of death, rather than the number of deaths reported in the year. For the death rates, the denominator is the population. Future reports will report diagnosis rates and death rates calculated in this way.

Highlighted findings

• From 1994 to 2000 in U.S. adolescents and adults, the median age at AIDS diagnosis increased from 37 to 39 years, the median age at death for persons with AIDS increased from 39 to 43 years, and the median age for persons living with AIDS increased from 38 to 41 years.
• From 1994 to 2000, the largest number of AIDS diagnoses occurred in adolescents and adults ages 30-34, 35-39, and 40-44 years. From 1994 to 1997, the largest number of deaths in adolescents and adults with AIDS occurred in persons ages 30-34, 35-39, and 40-44 years and from 1998 to 2000, the largest number of deaths shifted to adults ages 35-39, 40-44, and 45-49 years.
• In all age groups, the rate of AIDS diagnoses in adolescents and adults per 100,000 population and the rate of deaths in adolescents and adults with AIDS per 100,000 population decreased or remained stable from 1994 to 2000. At the end of 2000, the highest numbers of adolescents and adults living with AIDS per 100,000 population were observed in adults ages 35-39, 40-44, and 45-49 years.
• In 2000 in each age group, Black, non Hispanic adolescents and adults accounted for the largest number of the AIDS cases diagnosed and the largest number of deaths among persons with AIDS. In 2000, Black, non Hispanic adolescents and adults ages 13-24, 25-29, and 30-34 years accounted for the largest number of persons living with AIDS while approximately equal numbers of White, non Hispanic and Black, non Hispanic adolescents and adults ages 50-54, 55-59, 60-64, 65-69, and ≥70 years were living with AIDS.
• In each age group, the largest number in each exposure category for male adolescents and adults with an AIDS diagnosis in 2000 was male-male sexual contact and for female adolescents and adults was heterosexual contact.
• At the end of 2000, 322,796 persons were living with AIDS which is nearly twice the number of persons who were living with AIDS at the end of 1994. From 1994 to 1998, the largest number of adolescents and adults living with AIDS were ages 30-34, 35-39, and 40-44 years and in 1999 and 2000, adults ages 35-39, 40-44, and 45-49 years represented the age groups with the largest number of persons living with AIDS.
• The percentage change from 1994 to 2000 in the number of adolescents and adults living with AIDS per 100,000 population was negative for persons ages 13-24 and 25-29 years. The percentage change from 1994 to 2000 in the number of adults 30 years and older living with AIDS per 100,000 population was positive and was greatest for persons in the oldest age groups. Caution must be exercised when interpreting percent changes for a specific 5-year age group. This number does not represent a change over time for a specific birth group (e.g., persons born 1950-1954). It is a comparison of the number of persons in a specific age group (e.g., 40-44 year olds) at one point in time to a different group of persons that age at another point in time.

References

• Karon JM, Fleming PL, Steketee RW, DeCock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001;91:1060-1068.
• Janssen RS, Holtgrave DR, Valdiserri RO, Shepherd M, Gayle HD, DeCock DM. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am J Public Health 2001;91:1019-1024.