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

As of September 2, 1983, physicians and health departments in the United States and Puerto Rico had reported 2,259 persons with acquired immunodeficiency syndrome (AIDS) who met the surveillance case definition.* Of these, 917 (41%) are known to have died. Fifty-eight (3%) cases were diagnosed before 1981; 231 (10%) in 1981; 883 (39%) in 1982; and 1,087 (48%) to date in 1983. Pneumocystis carinii pneumonia (PCP) is the most common life-threatening opportunistic infection in AIDS patients, accounting for 52% of primary diagnoses; 26% of patients have Kaposi's sarcoma (KS) without PCP, and 7% 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. The proportion of patients with each of these primary diagnoses has remained relatively constant during the last 12 months, although the proportion with KS has decreased slightly, and the proportion with opportunistic infections other than PCP has increased from approximately 10% of all cases a year ago. Cases have occurred in all primary racial/ethnic groups in the United States: 57% of those reported have been white, 26% black, 14% Hispanic, and 3% other or unknown. One hundred forty-seven (7%) cases have been reported in women.

Eighty-nine percent of patients with AIDS can be placed in groups** that suggest a possible means of disease acquisition: 71% are men with homosexual or bisexual orientations; 17% (including 51% of the women) have used intravenous (IV) drugs; and 1% are hemophiliacs. Of the other 11% of cases, means of disease acquisition is less clear, but in none of these cases does casual contact appear to be involved. This group of 11% includes cases for whom information about risk factors is either absent or incomplete (3% of total), and others whose risk and exposure factors are under investigation. The latter includes patients who were born in Haiti but are now living in the United States (5% of total). Also under investigation are heterosexual partners of persons with AIDS or persons at increased risk of AIDS (1% of total), and those exposed to blood transfusions (1% of total). Finally, some thoroughly investigated cases belong to none of the above groups (1% of total).

Almost 47% of AIDS patients are 30-39 years old at diagnosis; an additional 22% are 20-29 and 40-49 years old, respectively. The age of drug-abuse patients clusters more tightly, with 81% being 20-39 years old. Compared with the average for all AIDS patients, Haitian entrants with AIDS tend to be younger (47% are 20-29 years old); the patients who received blood transfusions before developing AIDS tend to be older (median age more than 50 years old); and those with hemophilia tend to have a broader age range without clustering.

Most cases continue to be reported among residents of large cities. The New York City standard metropolitan statistical area (SMSA) has reported 42% of all cases meeting the surveillance definition; the San Francisco SMSA, 11% of cases; the Los Angeles SMSA, 7% of cases; and the Miami SMSA, 5% of cases. Cases have been reported from 41 states, the District of Columbia, and Puerto Rico (Figure 4). Reported by City, State, and Territorial Epidemiologists; AIDS Activity, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: AIDS cases have been classified into groups at greatest risk of acquiring the disease. Classification is an essential element of any epidemiologic investigation and serves such purposes as formulating prevention recommendations, providing direction for research, and identifying medical needs. However, the classification of certain groups as being more closely associated with the disease has been misconstrued by some to mean these groups are likely to transmit the disease through non-intimate interactions. This view is not justified by available data. Nonetheless, it has been used unfairly as a basis for social and economic discrimination.

The occurrence of AIDS cases among homosexual men, IV drug abusers, persons with hemophilia, sexual partners of members of these groups, and recipients of blood transfusions is consistent with the hypothesis that AIDS is caused by an agent that is transmitted sexually or, less commonly, through contaminated needles or blood. About 91% percent of reported cases have occurred in these patient groups. Among the remaining cases, there has been no evidence that the disease was acquired through casual contact with AIDS patients or with persons in population groups with an increased incidence of AIDS. AIDS is not known to be transmitted through food, water, air, or environmental surfaces.

The great majority of persons in population groups with increased incidences of AIDS have not been affected by the disease. Until epidemiologic studies identify the subgroups within these populations that are truly at increased risk for acquiring AIDS, the classification system will lack precision. However, such classifications should not be construed to imply that usual social contact with such groups is involved in the transmission of AIDS.

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