Current Trends Update: Acquired Immunodeficiency Syndrome --- United States, 1981 - 1990

In 1981, 189 cases of acquired immunodeficiency syndrome (AIDS), a newly recognized condition, were reported to CDC from 15 states and the District of Columbia; 76% of cases were reported from New York and California. Ninety-seven percent of cases reported were among men, 79% of whom reported being homosexual/bisexual (i.e., having had sex with other men); no cases were reported among children. In contrast, in 1990, more than 43,000 cases were reported, representing all states, the District of Columbia, and the U.S. territories; nearly two-thirds were reported from outside New York and California; more than 11% of adolescent and adult cases were in women; and nearly 800 cases were in children less than 13 years of age. These differences between 1981 and 1990 highlight the dramatic growth and increasing complexity of the AIDS epidemic. This report summarizes trends in the epidemiology of AIDS cases from 1981 through 1990 in the United States and updates AIDS cases in 1990.* AIDS, 1981--1990

During the 1980s, the number of reported AIDS cases increased each year. Homosexual/bisexual men and intravenous (IV)-drug users (i.e., persons who report a history of injecting drugs) have accounted for the largest number of AIDS cases throughout the epidemic. The total number of AIDS cases and of cases in these categories increased most rapidly during the middle 1980s, with more moderate increases in the late 1980s (Figure 1a).

Reported AIDS cases associated with heterosexual transmission of human immunodeficiency virus (HIV) have been increasing steadily, with cases occurring more frequently among women than among men (Figure 1b). Similarly, cases in children associated with perinatal (mother-to-infant) HIV transmission have continued to increase (Figure 1c). The number of AIDS cases associated with blood or blood product transfusions has stabilized (Figure 1d). AIDS, 1990

In 1990, 43,339 AIDS cases (17.2 per 100,000 population) were reported, accounting for more than one fourth (161,073) of all cases reported during 1981--1990. Homosexual/bisexual men and IV-drug users represented more than three fourths of reported cases (Table 1).

The number of cases reported per 100,000 population was higher for men, blacks and Hispanics, persons 30--39 and 40--49 years of age, and persons in the U.S. territories (primarily reflecting rates in Puerto Rico) and the Northeast region than for persons in other demographic groups or geographic areas (Table 1). Rates for reported cases among both women and men varied widely among states (Figure 2).

Women accounted for 11.5% of reported AIDS cases among adolescents and adults. Of the 4890 reported cases among adolescent and adult women in 1990, 2539 (51.9%) occurred among black women, 1236 (25.3%) among white women, and 1069 (21.9%) among Hispanic women. A history of IV-drug use was reported by 2329 (47.6%) women with AIDS. Heterosexual contact with a man infected with HIV or at high risk for HIV infection accounted for 1657 (33.9%) cases among women; 64.1% of these male sex partners were IV-drug users. Comparison of AIDS Cases in 1989 and 1990

The number of AIDS cases in 1990 was compared with the number in 1989 by two approaches: 1) cases reported during these two periods and 2) cases diagnosed during these two periods and adjusted for reporting delays. Differences in the comparisons are due to the effect of cases reported in 1990 but diagnosed in earlier years and cases diagnosed in 1990 but not yet reported.

Based on year of report, the number of AIDS cases increased by 35,230 to 43,339 (23%) from 1989 to 1990; based on year of diagnosis, cases increased from 41,200 to 44,200 (7%) (Table 1). In both comparisons, the largest proportionate increases occurred among women, blacks and Hispanics, persons living in the South (excluding the U.S. territories), and persons exposed to HIV through heterosexual contact (Table 1). However, the largest increases in the numbers of reported cases occurred among whites and among homosexual/bisexual men (Table 1). Reported by: Local, state, and territorial health departments. Div of HIV/AIDS, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

Since AIDS was first recognized and reported in 1981 (1), more than 179,000 persons with AIDS have been reported to public health departments in the United States. Of these, more than 113,000 (63%) are reported to have died. During this period, HIV infection has emerged as a leading cause of death among men and women less than 45 years of age and children 1--5 years of age in the United States (2).

The AIDS epidemic has expanded in scope and magnitude as HIV infection has affected different populations and geographic areas (3,4). Although homosexual/bisexual men continue to account for most AIDS cases, cases associated with IV-drug use are more common in several northeastern states (5). In 1990, the incidence of AIDS increased most rapidly among persons exposed to HIV through heterosexual contact. In addition, the rate of increase in AIDS cases was greatest in the South.

The total number of cases reported in 1990 represented an increase of more than 8000 cases from those reported in 1989, although the rate of increase in diagnosed cases was less than that for reported cases. When compared with diagnosed cases, the larger increase in reported cases may reflect more rapid reporting by health departments in 1990 to qualify for federal HIV-care funds. Assessment of reporting trends in 1991 should clarify these differences.

The slower rate of increase in AIDS cases diagnosed among homosexual/bisexual men than in earlier years may reflect a decline in the incidence of HIV infection among this group of men since the mid-1980s, as well as the effect of treatments that delay progression of HIV disease (6). Nonetheless, the increase in total diagnosed (1200) and reported cases (3847) from 1989 to 1990 was larger for these men than for persons who had other modes of HIV exposure.

Although the annual incidence of AIDS for persons who have received blood transfusions and persons with hemophilia has stabilized (Figure 1d), cases associated with these modes of HIV transmission continue to be diagnosed as a consequence of infections that occurred before screening of donated blood and heat treatment of clotting factors and because of the long period between infection with HIV and onset of AIDS. Although reported cases among transfusion recipients and persons with hemophilia increased, trends by year of diagnosis indicate that the number of such cases declined slightly or were relatively stable in 1990 (Table 1).

The need for services for HIV-infected persons is growing even more rapidly than indicated by trends in AIDS surveillance. The number of reported AIDS cases reflects illness among a substantially larger population of HIV-infected persons. However, antiretroviral therapies and other advances in care can delay the onset of AIDS among asymptomatic persons and lengthen the survival of those with AIDS. Other HIV-infected persons are ill but have not yet developed AIDS. The increasing diversity of the HIV/AIDS epidemic will further stress the ability of health-care systems to provide preventive and therapeutic services to HIV-infected persons.

References

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

2. CDC. Mortality attributable to HIV infection/AIDS---United States, 1981--1990. MMWR 1991;40:41--4.

3. CDC. National HIV seroprevalence surveys, summary of results, data from serosurveillance activities through 1989. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, September 1990.

4. Gardner LI, Brundage JF, Burke DS, et al. Evidence for spread of the human immunodeficiency virus into low prevalence areas of the United States. J Acquir Immune Defic Syndr 1989;2:521--32.

5. CDC. Update: acquired immunodeficiency syndrome associated with intravenous-drug use---United States, 1988. MMWR 1989;38:165--70.

6. Rosenberg PS, Gail MH, Schrager LK, et al. National AIDS incidence trends and the extent of zidovudine therapy in selected demographic and transmission groups. J Acquir Immune Defic Syndr 1991;4:392--401.

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