Current Trends Update: Acquired Immunodeficiency Syndrome (AIDS) -- United States

As of December 19, 1983, physicians and health departments in the United States have reported a total of 3,000 patients who meet the surveillance definition for acquired immunodeficiency syndrome (AIDS) (1). Of these patients, 51% were reported to have had Pneumocystis carinii pneumonia (PCP) without Kaposi's sarcoma (KS); 26%, KS without PCP; 7%, both KS and PCP; and 16%, opportunistic infections without either KS or PCP. A total of 1,283 (43%) of reported patients are known to have died; the proportion of patients with KS alone who have died (23%) is less than half that of other AIDS patients (50%). Of the 3,000 patients, 90% have been between 20 and 49 years old. Fifty-nine percent of the cases have occurred among whites, 26% among blacks, and 14% among persons of Hispanic origin. Women account for 7% of the cases.

AIDS was first reported in the spring of 1981 (2,3), although patients with diagnoses meeting the surveillance definition for AIDS were, in retrospect, seen earlier (Figure 3). Half the 3,000 reported AIDS patients have been diagnosed since February 1983.

Cases have been reported from 42 states, the District of Columbia, and Puerto Rico (Figure 4). Eighty-one percent of the patients were residents of New York, California, Florida, or New Jersey at the time of their onsets of illness. Within these states, most cases have been reported among residents of large cities. The standard metropolitan statistical areas that have reported the greatest number of cases include: New York City (42% of all AIDS patients), San Francisco (12%), Los Angeles (8%), Miami (4%), and Newark (3%).

Groups at highest risk of acquiring AIDS continue to be homosexual and bisexual men (71% of cases) and intravenous drug abusers (17%); 12% of patients have other or unknown risk factors. These include persons born in Haiti and now living in the United States (5% of total cases), patients with hemophilia (1%), heterosexual contacts of persons at increased risk for acquiring AIDS (1%), and recipients of blood transfusions (1%).

The 31 patients with "transfusion-associated" AIDS include 18 men and 13 women who have no other known risk factor for AIDS and were transfused with blood or blood components within 5 years of their onsets of illness. These patients received transfusions between April 1978 and May 1983. Twelve are known to have died.

Not included in the 3,000 case reports are 42 children under the age of 5 years who meet a provisional case definition for pediatric AIDS (Table 1). All had life-threatening opportunistic infections; two also had KS (4). Twenty-nine (69%) are known to have died.

Twenty-nine of the children came from families in which one or both parents had a history of intravenous drug abuse (17 children) or were born in Haiti (12 children). Three of the 29 children, including one previously reported (5), have had a parent (two mothers, one father) with AIDS. Of the other 13 children, seven had transfusions with blood or blood components before their onsets of illness. One of these children received a platelet transfusion from a man who died of AIDS (6). Reported by State and Territorial Epidemiologists; AIDS Activity, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Although the rate of increase of diagnosed AIDS cases appears lower for the last half of 1983 than previously, trends in reported AIDS incidence must be interpreted cautiously. For example, several months often elapse between the diagnosis of an AIDS patient and the receipt of the case report at CDC; the number of reported cases lags behind the true incidence of disease. Also, during the past year, AIDS reporting has been decentralized, so that most cases are reported to state and local health departments, which forward reports to CDC. Final interpretation of trends in AIDS incidence for the last half of 1983 will, therefore, require several more months.

Because children are subject to a variety of congenital immunodeficiencies, confirmation of AIDS diagnoses in children is more complex than in adults. Laboratory testing to exclude congenital conditions is required. In future surveillance summaries, CDC will give the number of children reported to meet the provisional case definition for pediatric AIDS.

References

1. Jaffe HW, Bregman DJ, Selik RM. Acquired immune deficiency syndrome in the United States: the first 1,000 cases. J Infect Dis 1983;148:339-45.

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

3. CDC. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR 1981;30:305-8.

4. Buck BE, Scott GB, Valdes-Dapena M, Parks WP. Kaposi sarcoma in two infants with acquired immune deficiency syndrome. J Pediatr 1983;103:911-3.

5. CDC. Unexplained immunodeficiency and opportunistic infections in infants--New York, New Jersey, California. MMWR 1982;31:665-7.

6. Ammann AJ, Cowan MJ, Wara DW, et al. Acquired immunodeficiency in an infant: possible transmission by means of blood products. Lancet 1983;I:956-8. TABLE 1. Provisional case definition for acquired immunodeficiency syndrome (AIDS) in children

For the limited purposes of epidemiologic surveillance, CDC defines a case of pediatric acquired immunodeficiency syndrome (AIDS) as a child who has had:

1. a reliably diagnosed disease at least moderately indicative of underlying cellular immunodeficiency and

2. no known cause of underlying cellular immunodeficiency or any other reduced resistance reported to be associated with that disease. The diseases accepted as sufficiently indicative of underlying

cellular immunodeficiency are the same as those used in defining AIDS in adults (1) with the exclusion of congenital infections, e.g., toxoplasmosis or herpes simplex virus infection in the first month after birth or cytomegalovirus infection in the first 6 months after birth.

Specific conditions that must be excluded in a child are:

1. Primary immunodeficiency diseases--severe combined immunodeficiency, DiGeorge syndrome, Wiskott-Aldrich syndrome, ataxia-telangiectasia, graft versus host disease, neutropenia, neutrophil function abnormality, agammaglobulinemia, or hypogammaglobulinemia with raised IgM.*

2. Secondary immunodeficiency associated with immunosuppressive therapy, lymphoreticular malignancy, or starvation.

*Immunodeficiency. WHO Technical Report Series 1978;630:28-31.

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