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.
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).
CDC. Years of potential life lost before age 65--United States,
1987. MMWR 1989;38:27-9.
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.
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.
CDC. AIDS and human immunodeficiency virus infection in the
United
States: 1988 update. MMWR 1989;38(no. S-4):11
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.
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.
CDC. HIV infection reporting--United States. MMWR 1989;38:496-9.
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