Current Trends Acquired Immunodeficiency Syndrome (AIDS) Update - - United States

As of June 20, 1983, physicians and health departments in the United States and Puerto Rico had reported a total of 1,641 cases of acquired immunodeficiency syndrome (AIDS). These cases were diagnosed in patients who had Kaposi's sarcoma (KS) or an opportunistic infection suggestive of an underlying cellular immunodeficiency. Of these patients, 644 (39%) are known to have died; the proportion of patients with KS alone who have died (22%) is less than half that of patients with opportunistic infections who have died (46%). Fifty-five (3%) cases were diagnosed before 1981; 225 (14%), in 1981; 832 (51%), in 1982; and 529 (32%), to date in 1983. Pneumocystis carinii pneumonia (PCP) is the most common life-threatening opportunistic infection in AIDS patients, accounting for 51% of primary diagnoses; 26% of patients have KS without PCP, and 8% have both PCP and KS. Many of these patients may also have other opportunistic infections, and 15% of AIDS patients have such infections without KS or PCP. Over 90% of AIDS patients are 20-49 years old; almost 48% are 30-39 years old. Cases have occurred in all primary racial groups in the United States. Only 109 (7%) cases have been reported in women.

Groups at highest risk of acquiring AIDS continue to be homosexual and bisexual men (71% of cases), intravenous drug users (17%), persons born in Haiti and now living in the United States (5%), and patients with hemophilia (1%)*. Six percent of the cases cannot be placed in one of the above risk groups; approximately half of these are patients for whom information regarding risk factors is either absent or incomplete. The remainder includes, in order of decreasing frequency, patients with no identifiable risk factors, heterosexual partners of AIDS patients or persons in risk groups, recipients of blood transfusions, and KS patients with normal immunologic studies. Of the 109 cases among females, 52% occurred among drug users and 9% among Haitians; for 39%, the risk group is unknown.

In addition to the 1,641 reported AIDS cases, 21 infants with opportunistic infections and unexplained cellular immunodeficiencies have been reported to CDC. Infant cases are recorded separately because of the uncertainty in distinguishing their illnesses from previously described congenital immunodeficiency syndromes.

Most cases continue to be reported among residents of large cities. New York City has reported 45% of all cases meeting the surveillance definition**; San Francisco, 10% of cases; and Los Angeles, 6% of cases. Cases have been reported from 38 states, the District of Columbia, and Puerto Rico (Figure 1). Reported by State and Territorial Epidemiologists; AIDS Activity, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: During 1982 and early 1983, city and state health departments throughout the United States began assuming an increasingly active role in the surveillance and investigation of AIDS. At the annual Conference of State and Territorial Epidemiologists in May 1983, the group affirmed the urgency of AIDS as a public health problem and passed, as one part of a resolution on AIDS, the recommendation that AIDS be added to the list of notifiable diseases in all states. The method of making a disease notifiable varies markedly in different states, ranging from a change in state law to regulatory action by the Board of Health or executive decision by the health officer. Several states have already made AIDS notifiable; other states are taking similar action.

Case counts of patients with AIDS listed by cities or states may differ from those listed by CDC. The standard surveillance definition of AIDS does not apply to suspected subclinical or mild cases of AIDS--to the extent they occur--or to cases involving persistent generalized lymphadenopathy or other conditions in persons from high-risk groups. Some AIDS patients may seek treatment in cities other than those in which they reside and may be reported through health departments in cities where they are treated. CDC eliminates duplicate reports and assigns each patient to the city and state of residence at the time of reported onset of illness. In addition, the processing of case reports may result in a delay between diagnosis, reporting, and entry of a case into the registry at the different health departments or CDC.

Physicians aware of patients fitting the case definition for AIDS are requested to report such cases to CDC through their local or state health departments. AIDS patients who do not belong to any of the recognized risk groups or who are recipients of blood or blood products (including anti-hemophiliac factors) should be reported immediately.

The vast majority of cases continue to occur among persons in the major identified risk categories. The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread (1). The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk. Most of the 21 infants with unexplained immunodeficiency have been born to mothers belonging to high-risk groups for AIDS (2). If this syndrome is, indeed, AIDS, the occurrence in young infants suggests transmission from an affected mother to a susceptible infant before, during, or shortly after birth. Previously published guidelines to prevent the transmission of AIDS and precautions for health care and laboratory workers are still applicable (1,3).

References

1. CDC. Acquired immune deficiency syndrome (AIDS): precautions for clinical and laboratory staffs. MMWR 1982;31:577-80.

2. CDC. Unexplained immunodeficiency and opportunistic infections in infants-New York, New Jersey, California. MMWR 1982;31:665-7.

3. CDC. Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations. MMWR 1983;32:101-3.

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