CDC epidemiological report highlights testing limits

Changes in types of AIDS deaths noted

9th Conference
on Retroviruses

About half of the nearly 1 million people who have HIV infection in the United States are not receiving ongoing care, and this largely is due because they have not yet been diagnosed, according to data from the Centers for Disease Control and Prevention of Atlanta. The CDC data were presented at the 9th Conference on Retroviruses and Opportunistic Infections, held Feb. 24-28, 2002, in Seattle. CDC officials estimate that HIV prevalence in the United States has increased by about 50,000 people since 1998 and that there are now between 850,000 and 950,000 people infected with the virus.1

"We assumed that during 1999 and 2000 HIV incidence was approximately constant and that the prevalence was increasing because of increased survival of people with AIDS," says Patricia L. Fleming, PhD, chief of the surveillance branch of the CDC’s Division of HIV/AIDS Prevention.

Another major finding that CDC investigators presented at the conference is that about 40% of HIV patients began treatment late, and that people of color, injection drug users, and heterosexuals were more likely to initiate treatment late. "We estimate there are 670,000 people who are diagnosed with HIV, excluding people who were tested anonymously," Fleming says. Of the 670,000 who are diagnosed, the CDC estimates that about one-third have not received care for their disease, Fleming says. The good news is that it appears the percentage of HIV-infected people who are tested and diagnosed has increased in the past few years, although it’s still far from ideal, she says.

Ryan White money to be based on HIV cases

"We want to increase HIV testing by providers so those who are infected know early in the disease and can benefit from early treatment and live longer and healthier lives," Fleming says. If an estimated 450,000 people have received treatment for their HIV infection, there remain another 400,000 to 450,000 people who have not, Fleming says. "So we have to do a better job of facilitating referrals to care and treatment."

The CDC’s ability to track HIV trends still is limited by the fact that some states still have not initiated an HIV reporting program. This should improve within the next few years as the Ryan White Care Act authorization of 2000 goes into effect, Fleming says. In this authorization, Congress gave states a deadline for reporting HIV cases. Beginning in 2004 and no later than 2007, the distribution of Ryan White money will be based on HIV cases and not just on AIDS cases, Fleming explains. "This is an important motivation for states to adopt CDC guidelines for reporting HIV cases, because ultimately Congress will tie data for HIV to reimbursement," Fleming says.

Reference

1. Fleming PL, Byers RH, Sweeney PA, et al. HIV prevalence in the United States, 2000. Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Abstract 11.