Epidemiological trends of AIDS in the United States.

The incidence of acquired immunodeficiency syndrome (AIDS) in the United States has increased rapidly since the first reports in 1981. Highest estimated rates are among single (never-married) men in Manhattan and San Francisco, men and women who have abused drugs intravenously, and persons with hemophilia. Serosurveys among populations at increased risk for AIDS have demonstrated a high prevalence of antibody to human T-cell leukemia virus III-lymphadenopathy-associated virus (HTLV-III/LAV), the virus which causes AIDS. The discovery of the virus and the widespread availability of serological tests greatly increase the ability to understand AIDS and to study the natural history of HTLV-III/LAV infection.

Opportunistic diseases reported in AIDS patients: frequencies, associations, and trends.

To look for associations and trends in the reported frequencies of particular opportunistic diseases in AIDS patients, we analyzed diseases in the 30,632 AIDS patients in the United States reported to the Centers for Disease Control (CDC) by 9 February 1987. Compared with all other AIDS patients, children were three times more likely to have cytomegalovirus disease, homosexual men were seven times more likely to have Kaposi's sarcoma, and Haitian-born patients were six, 14 and 13 times more likely to have toxoplasmosis, tuberculosis, and chronic enteric isosporiasis, respectively. The proportions of patients initially presenting with particular diseases have changed; from before 1983 to 1986, the proportion with Pneumocystis pneumonia climbed from 41.9 to 63.6% and the proportion with extrapulmonary cryptococcosis rose from 4.5 to 6.2%, while Kaposi's sarcoma fell from 30.9 to 14.2%, chronic herpes simplex declined from 4.2 to 2.1%, and toxoplasmosis of the brain dropped from 3.5 to 1.5%.

Acquired immunodeficiency syndrome in children: report of the Centers for Disease Control National Surveillance, 1982 to 1985.

Since national surveillance for acquired immunodeficiency syndrome (AIDS) began in 1981, the Centers for Disease Control (CDC) has received reports of more than 20,000 cases of AIDS in the United States. As of December 31, 1985, 307 of these cases had been diagnosed in children younger than 13 years of age. The number of cases is increasing rapidly. The number of cases reported in 1985 more than doubled those reported in 1984. The major risk factors in children for acquiring infection with the causative agent, human immunodeficiency virus (HIV), were having a mother known to be infected and/or at increased risk for infection and receiving a transfusion of blood or blood products. Of the 307 children with AIDS, 73% were reported from one of four states: New York, New Jersey, Florida, and California. Most AIDS cases in children occur in black or Hispanic infants and toddlers. The estimated incubation period for AIDS in children has increased each surveillance year, with the longest incubation exceeding 7 years. The prognosis for children with AIDS is poor and infants less than 1 year of age have the shortest survival time following diagnosis. Continued national surveillance for AIDS is mandatory for establishing effective prevention programs to control the spread of the disease. The CDC encourages all health care personnel to report cases of AIDS to their public health departments.

Review of death certificates to assess completeness of AIDS case reporting.

To assess the level of reporting of acquired immunodeficiency syndrome (AIDS) cases, the authors reviewed death certificates for periods of 3 months during July through December 1985 in each of four cities: Washington, DC, New York City, Boston, and Chicago. Since reporting began in 1981, these cities have reported 38 percent of all AIDS cases in the United States. Death certificates were selected and matched to the AIDS surveillance registries in each city, and medical records of those not on the AIDS registry were reviewed to determine if AIDS had been diagnosed. The estimated completeness of AIDS case reporting to AIDS surveillance systems was high in all four cities (ranging from 83 percent to 100 percent). The unreported cases were similar to reported cases with respect to sex, race, risk factor, and specific diagnosis. Of the causes of death examined, AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma were predictive of AIDS as defined by the CDC case definition. However, 77 of 588 deaths (13 percent) attributed to 1 of these 3 causes occurred in cases that were presumptively AIDS but did not meet the diagnostic requirements to be classified as AIDS for reporting purposes. A review of death certificates provides an easy and rapid means of evaluating surveillance efforts and can be a useful adjunct to other methods of surveillance for AIDS.

Establishing efficient interview periods for gonorrhea patients.

From February through December 1978, venereal disease casefinders in Polk County, Iowa used an expanded interview period of at least 120 days to interview 983 gonorrhea patients for sexual partner information. We grouped patients according to sex and clinical findings and evaluated the percentage of all new cases identified by time intervals within the expanded interview period. Ninety-one per cent of all untreated, infected sexual partners of symptomatic males were identified by using an interview period which spanned the interval from date of treatment to 15 days before symptom onset. In contrast, the traditional 30-day interview period missed 23 per cent of those untreated, infected partners named by women with pelvic inflammatory disease (PID), 34 per cent of those partners named by women with uncomplicated gonorrhea, and 29 per cent of those named by asymptomatic men. The Polk County data suggest the importance of basing interview periods upon a patient's sex and clinical presentation.