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Current Trends First 100,000 Cases of Acquired Immunodeficiency Syndrome -- United States

In June 1981, the first cases of the illness now known as acquired immunodeficiency syndrome (AIDS) were reported from Los Angeles in five young homosexual men diagnosed with Pneumocystis carinii pneumonia and other opportunistic infections (1). Since then, state and territorial health departments have reported greater than 100,000 cases of AIDS and greater than 59,000 AIDS-related deaths to CDC. AIDS is now a major cause of morbidity and mortality in children and young adults in the United States, ranking 15th among leading causes of death in 1988 (2) and seventh among estimated years of potential life lost before age 65 in 1987 (3). The first 50,000 cases of AIDS were reported to CDC from 1981 to 1987; the second 50,000 were reported between December 1987 and July 1989.

Although homosexual/bisexual men still account for most reported AIDS cases, intravenous-drug users (IVDUs), their sex partners, and their children represent an increasing proportion of all cases. Of AIDS cases reported before 1985, 63% were homosexual/bisexual men with no history of IV-drug use, 18% were female or heterosexual male IVDUs, and 2% were sex partners or children of IVDUs or their sex partners. In contrast, of the AIDS cases reported in the first 6 months of 1989, 56% were homosexual/bisexual men with no history of IV-drug use, 23% were female or heterosexual male IVDUs, and 4% were sex partners or children of IVDUs or their sex partners. The proportion of AIDS cases among women has also increased from 7% of cases reported before 1985 to 11% of cases reported in the first 6 months of 1989. Blacks and Hispanics continue to be disproportionately represented among all persons with AIDS and particularly among IVDUs with AIDS (Table 1). Although most AIDS cases are reported from large metropolitan areas, an increasing proportion are being reported from smaller cities and rural areas. Metropolitan statistical areas with populations less than or equal to 500,000 reported 10% of all U.S. cases before 1985, compared with 19% in 1988. Reported by: AIDS Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The 100,000 AIDS cases reported in the United States as of July 1989 represent the minimum number of persons with severe human immunodeficiency virus (HIV)-related disease. Because of the combination of underdiagnosis and underreporting of AIDS cases and severe manifestations of HIV infection that do not meet the CDC AIDS surveillance case definition, reported AIDS cases underestimate the number of persons severely affected by HIV since 1981. The completeness of diagnosis and reporting of AIDS cases varies by geographic region and patient population; however, mortality studies suggest that 70%-90% ff HIV-related deaths are identified through national surveillance of AIDS (4).

The number of AIDS cases are one indication of the larger epidemic of HIV infection. An estimated 1-1.5 million persons are infected with HIV in the United States (5), with recent seroprevalence studies suggesting that the actual number is closer to the lower end of this range (6). A cohort study of homosexual/bisexual men in San Francisco suggests that 54% of infected persons will develop AIDS within 10 years of infection (7) and that up to 99% will eventually develop AIDS (8). Therefore, the number of persons with AIDS and other severe manifestations of HIV infection will continue to increase.

AIDS is reportable in all 50 states, the District of Columbia, and U.S. territories. AIDS surveillance has been crucial in identifying characteristics of persons at risk for the disease and modes of transmission and remains extremely important in monitoring trends in severe HIV-related disease, projecting future numbers of AIDS cases and HIV-infected persons, and targeting resources for prevention and treatment efforts. Because persons with AIDS require a broad range of medical services, documentation of these cases is also important in determining current and future health-care needs and costs. AIDS surveillance data together with information from the HIV family of surveys (6) and HIV infection reporting (9) are important components of public health programs directed toward controlling HIV infection and assist in providing the most accurate picture of the HIV epidemic in the United States.

References

  1. CDC. Pneumocystis pneumonia--Los Angeles. MMWR 1981;30:250-2.

  2. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (PHS)89-1120. (Monthly vital statistics report; vol 37, no. 13).

  3. CDC. Years of potential life lost before age 65--United States, 1987. MMWR 1989;38:27-9.

  4. Buehler J, Berkelman R, Devine O. Estimate of HIV-related deaths in young adult men, United States, 1986 (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:124.

  5. Office of the Assistant Secretary for Health. Report of the second Public Health Service AIDS Prevention and Control Conference. Public Health Rep 1988;103(suppl 1):3.

  6. CDC. AIDS and human immunodeficiency virus infection in the United States: 1988 update. MMWR 1989;38(no. S-4):11

  7. Lifson A, Hessol N, Rutherford GW, et al. The natural history of HIV infection in a cohort of homosexual and bisexual men: clinical manifestations, 1978-1989. (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:60.

  8. Lui K-J, Darrow WW, Rutherford GW III. A model-based estimate of the mean incubation period for AIDS in homosexual men. Science 1988;240:1333-5.

  9. CDC. HIV infection reporting--United States. MMWR 1989;38:496-9.



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