Current Trends Update: Acquired Immunodeficiency Syndrome -- United States

As of April 30, 1985, physicians and health departments in the United States had reported 10,000 patients (9,887 adults and 113 children) meeting the surveillance definition for acquired immunodeficiency syndrome (AIDS) (1,2). Since the initial reports of AIDS in the spring of 1981 (3,4), the number of cases reported each half-year has increased (Figure 1). Over half of the 10,000 cases have been reported within the last 12 months. Four thousand nine hundred forty-two of all reported patients are known to have died (49% of the adults and 69% of the children); 75% of patients diagnosed before January 1983 are known dead.

Adult patients. Among adult AIDS patients, there has been no significant change over time in distribution by age, race, and sex. Ninety percent of adult patients are 20-49 years old. Sixty percent are white; 25%, black; and 14%, Hispanic. Ninety-four percent are men.

Reported cases have increased substantially in all patient groups. However, some changes in the relative proportion of cases have been noted. Since 1981, the proportion of AIDS cases in transfusion recipients has increased significantly (p 0.01), while the proportion of cases in "other/unknown" patients has decreased significantly (p 0.001) (Table 1). The latter reflects a smaller rate of increase of AIDS among Haitian-born patients who are placed in the "other/unknown" category. Although there has been a slight increase in the proportion of patients who are homosexual/bisexual men, it is not statistically significant.

The proportion of adult patients with Kaposi's sarcoma (KS) alone and with both KS and Pneumocystis carinii pneumonia (PCP) has decreased significantly (p 0.001) (Table 2). This is associated with a significant increase in the proportion of cases with PCP and no KS. The distribution of cases with other opportunistic diseases has remained relatively constant.

Adult AIDS patients have been reported from 46 states, the District of Columbia, and three U.S. territories. Among cases reported before May 1983, 47% of the adults were residents of New York. Between May 1984 and April 1985, the proportion of adults reported with AIDS from this state decreased significantly (p 0.001) to 34% of the total.

Pediatric patients. Among AIDS patients under 13 years old, there has been no statistically significant change in distribution by age, race, sex, and disease presentation over time. Fifty-eight percent of the pediatric patients were under 1 year old at diagnosis. Fifty-five percent are black; 22%, white; and 21%, Hispanic. Sixty-three percent are male. Sixty-eight percent had PCP without KS; 2% had KS and PCP; 4% had KS without PCP; and 26% had other opportunistic diseases. Eighty-one (72%) of the 113 pediatric patients came from families in which one or both parents had AIDS or were at increased risk for developing AIDS; 15 (13%) had received transfusions of blood or blood components before their onsets of illness, and six (5%) had hemophilia. Risk factor information on the parents of the 11 (10%) remaining patients is incomplete. Pediatric cases have been reported from 17 states; cases reported per state ranged from one to 53 (median one). Eighty-two percent of the pediatric cases have been reported from New York, New Jersey, Florida, and California. Of the 81 pediatric patients with a parent with AIDS or at increased risk for AIDS, 69 (85%) were residents of New York, New Jersey, or Florida--states in which over 84% of the heterosexual adult cases were reported. Reported by State and Territorial Epidemiologists; AIDS Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The number of AIDS cases reported nationally continues to increase. The first 5,000 diagnosed cases were reported to CDC between June 1981 and June 1984 (37 months); the last 5,000 cases have been reported since June 1984 (10 months).

Haitian-born AIDS patients have now been placed into the "other/unknown" group. The previous separate listing for Haitian-born patients has been discontinued in light of current epidemiologic information that suggests both heterosexual contact and exposure to contaminated needles (not associated with intravenous (IV) drug abuse) play a role in disease transmission (5-7). Similar risk factors have been described for AIDS patients in some central African countries (8-10). Evidence from surveillance case report forms is insufficient to establish the specific modes of transmission in particular cases reported among Haitian immigrants.

Among Haitian-American control patients who were age- and sex-matched to patients with AIDS, the prevalence of antibody to human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) was 5% (7). While this seroprevalence is lower than that found in other patient groups, it is several times higher than that seen in random blood donors. The following U.S. Public Health Service guidelines continue to apply: blood and/or plasma should not be donated by persons with symptoms and signs of AIDS, sexual partners of AIDS patients, sexually active homosexual/bisexual men with multiple partners, Haitian entrants to the United States, present or past abusers of IV drugs, patients with hemophilia, and sexual partners of individuals at increased risk for AIDS (11).

The proportion of AIDS patients with a history of blood transfusion as their only risk factor has increased significantly during the last 2 years, although these cases still contribute less than 2% of the total. Because the time from infection with HTLV-III/LAV to onset of AIDS may be several years, persons exposed to the virus through transfusion before institution of the self-deferral guidelines for blood donors in 1983 and screening of blood for HTLV-III/LAV antibody in 1985 may remain at risk of AIDS.

Over 93% of all AIDS patients who have KS are homosexual/bisexual men (12). Although the proportion of homosexual/bisexual men reported with AIDS has been increasing, the proportion with KS has decreased significantly and has led to an overall decrease in the proportion of adult cases with KS. The reasons for the change in proportion of KS cases among homosexual/bisexual men are unclear.

Forty-five states, the District of Columbia, and Puerto Rico now require reporting of AIDS to health departments. Although the majority of cases have been reported from a few states, proportionately greater increases have recently been noted from other states. The geographic distribution of AIDS among children with parents in high-risk groups is similar to that seen for heterosexual adult AIDS patients. Since several years usually separate acquisition of infection with HTLV-III/LAV and onset of AIDS, current reports of AIDS cases may not reflect the present geographic distribution of infected persons.

References

1. CDC. Update: acquired immunodeficiency syndrome (AIDS)--United States. MMWR 1984;32:688-91.

2. Selik RM, Haverkos HW, Curran JW. Acquired immune deficiency syndrome (AIDS) trends in the United States, 1978-1982. Am J Med 1984;76:493-500.

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

4. CDC. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR 1981;30:305-8.

5. Pape J, Liautaud B, Thomas F, et al. Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti. N Engl J Med 1983;309:945-50.

6. Pape J, Liautaud B, Thomas F, et al. AIDS: risk factors in Haiti. Washington, D. C.: Twenty-fourth Interscience Conference on Antimicrobial Agents and Chemotherapy, 1984:99 (abstract #60).

7. Castro KG, Fischl MA, Landesman SH, et al. Risk factors for AIDS among Haitians in the United States. Atlanta, Georgia: International Conference on AIDS, April 16, 1985.

8. Piot P, Quinn TC, Taelman H, et al. Acquired immunodeficiency syndrome in a heterosexual population in Zaire. Lancet 1984;11:65-9.

9. Van de Perre P, Rouvroy D, Lepage P, et al. Acquired immunodeficiency syndrome in Rwanda. Lancet 1984;11:62-5.

10. Kapita BM, Mann JM, Francis H, Ruti K, Quinn T, Curran JW. HTLV-III seroprevalence among hospital workers in Kinshasha, Zaire. Atlanta, Georgia: International Conference on AIDS. April 17, 1985.

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

12. CDC. Update: acquired immunodeficiency syndrome (AIDS)--United States. MMWR 1983;32:389-91.

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