All 50 states and the District of Columbia require health-care
providers to report new cases of acquired immunodeficiency syndrome
(AIDS) to their state health departments. As of July 1989, 28 (56%)
states also required reporting of persons infected with human
immunodeficiency virus (HIV) (Figure 1). In addition, 10 states (as
of
May 1989) have proposals on reporting currently before their
legislatures, governors, or voting constituencies.
The 28 states that require HIV infection reporting account for 45%
of
the U.S. population and 24% of U.S. AIDS cases reported as of June
30,
1989. States with HIV infection reporting had a lower median
cumulative
incidence of AIDS (388 AIDS cases per state or 14 cases per 100,000
population) than states without reporting (1244 AIDS cases per
state or
31 cases per 100,000 population). Thirteen (46%) states with HIV
infection reporting had greater than 500 cumulative AIDS cases,
compared with 14 (64%) states without reporting.
Reporting systems among the 28 states have been developed
independently and therefore vary widely in methodology and
information
collected. In 21 (75%) states, reporting is the responsibility of
both
the physician caring for the patient and the laboratory that tested
the
patient's blood for HIV antibody. In five (18%) states, reporting
is
the physician's responsibility alone, and in two (7%) states, it is
the
laboratory's responsibility alone. Twenty (71%) states require a
positive result on a supplemental test (Western blot or
immunofluorescence assay) in addition to a repeatedly reactive
enzyme
immunoassay (EIA) before a patient is reported; three (11%) states
will
accept reports on patients repeatedly reactive on EIA; five (18%)
states will accept reports on patients reactive on an initial EIA.
All
states, however, recommend supplemental testing before patient
follow-up or initiation of partner notification procedures.
Eighteen (64%) of the 28 states require HIV reporting by patient's
name (Figure 1); however, under certain circumstances, 10 of the 18
states permit anonymous testing and therefore do not receive names
on
some reports. Most states request basic demographic data, and more
than
half request HIV risk information. Twelve (43%) collect clinical
information, e.g., eight (29%) ask whether the patient was
symptomatic,
and four (14%) collect sufficient information to allow use of the
CDC
HIV infection classification system (1).
Reported by: State and territorial health departments. AIDS
Program,
Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: HIV infection reports are useful in directing
HIV-related prevention activities such as patient counseling,
partner
notification, and referral for appropriate medical management
(e.g.,
evaluation for prophylaxis against Pneumocystis carinii pneumonia
(2)).
Reporting of HIV-infected persons may enable earlier recognition of
persons with or at risk for HIV infection and earlier interventions
to
prevent further spread of HIV. Recent guidelines for initiation of
therapy in some HIV-infected persons emphasize the need for
identifying
persons who need treatment before the diagnosis of AIDS is made
(2).
HIV infection reports are also useful for guiding pediatric medical
and
social support programs, including programs for infants whose
infection
status may remain undetermined until they are greater than or equal
to
15 months of age (3). Prevention activities and medical management
of
patients can be carried out without requiring HIV infection
reporting
(4), but a reporting system can provide a framework for maintaining
these activities.
HIV infection reports that are now integral to public health
programs
in many states are not anticipated to be representative of all
HIV-infected persons. Such reports represent only those persons
within
the infected population who are tested and reported at a given
time.
Testing and reporting may be influenced by factors other than the
incidence and prevalence of AIDS, e.g., public awareness of risk
factors, confidentiality concerns, and testing accessibility. While
HIV
infection reports complement other HIV/AIDS studies of HIV
infection in
a community (5,6), AIDS surveillance and the HIV family of surveys
(7)
remain the basis for determining the current status and course of
HIV
infection in the United States.
In February 1989, CDC conducted a workshop for all states that had
had
HIV infection reporting for at least 1 year and selected states
that
had initiated reporting more recently or were considering
initiating
reporting. The workshop addressed standardization of HIV infection
reports to increase their usefulness and to enable a comparison of
results between states. Participants developed recommendations for
states with HIV infection reporting (Table 1) and affirmed the
continued need for AIDS surveillance and HIV serosurveys.
References
1. CDC. Classification system for human T-lymphotropic virus type
III/lymphadenopathy-associated virus infections. MMWR
1986;35:334-9.
2. CDC. Guidelines for prophylaxis against Pneumocystis carinii
pneumonia for persons infected with human immunodeficiency virus.
MMWR
1989;38(no. S-5).
3. CDC. Classification system for human immunodeficiency virus
(HIV)
infection in children under 13 years of age. MMWR
1987;36:225-30,236.
4. Blankenship EM, Owen-O'Dowd JM, Jolly DH, Petz WJ, Meriwether
RA.
HIV partner notification within an anonymous testing system
(Abstract).
V International Conference on AIDS. Montreal, June 4-9, 1989:743.
5. Hoffman RE, Valway SE, Wolf FC, et al. Comparison of AIDS and
HIV
antibody surveillance data in Colorado. J Acquired Immune
Deficiency
Syndromes 1989;2:194-200.
6. MacDonald K, Danila R, Reier D, Heiser J, Stiepan D, Osterholm
M.
Surveillance for HIV infection in Minnesota: results from the first
three years of operation (Abstract). V International Conference on
AIDS. Montreal, June 4-9, 1989:59.
7. CDC. AIDS and human immunodeficiency virus infection in the
United
States: 1988 update. MMWR 1989;38(no. S-4):8-11.
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