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

As of June 18, 1984, physicians and health departments in the United States had reported 4,918 patients meeting the surveillance definition for acquired immunodeficiency syndrome (1,2). Over 70% of the adult AIDS patients and nearly 80% of the pediatric patients have been reported since January 1983 (Figure 1). Although 2,221 (45%) of all reported patients are known to have died (45% of the adults and 68% of the children), more than 76% of patients diagnosed before July 1982 are dead.

Adult patients: Among 4,861 adult AIDS patients, Pneumocystis carinii pneumonia (PCP) continues to be the most common opportunistic disease. Fifty-three percent of patients had PCP without Kaposi's sarcoma (KS); 24% had KS without PCP; 6% had both PCP and KS; and 17% had other opportunistic diseases without either PCP or KS. Of the 1,502 patients with KS, 1,396 (93%) have been homosexual or bisexual men. Ninety percent of adult AIDS patients are 20-49 years old, and 333 (7%) are women. Fifty-eight percent of the cases have occurred among whites; 25%, among blacks; and 14%, among persons of Hispanic origin.

Groups at highest risk of acquiring AIDS continue to be homosexual or bisexual men (72% of patients) and intravenous drug abusers (17%); 11% of patients have other or unknown risk factors. These include persons born in Haiti (4% of total cases), patients with hemophilia (1%), heterosexual partners of persons with AIDS or at increased risk for acquiring AIDS (1%), and recipients of blood transfusions (1%). The 52 adults with "transfusion-associated" AIDS have no other known risk factor for AIDS and were transfused with blood or blood components within 5 years of illness onset. Twenty-seven (52%) are known to have died. To examine possible trends in all patient groups, adult patients were divided into four equal categories based on date of report (Table 1). Except for a statistically significant decrease in the proportion of Haitian-born patients (p 0.001), the distribution of cases by patient groups has remained relatively constant over time.

Seventy-eight percent of the adults were reported to be residents of New York, California, Florida, or New Jersey at the time of their onsets of illness. The remaining patients were reported from 41 other states, the District of Columbia, and Puerto Rico. Over time, the proportion of patients from New York has significantly decreased (p 0.001), while the proportion for other states has significantly increased (p 0.001) (Table 2).

Pediatric patients: Of the 57 patients under 5 years of age, 45 (79%) were reported to be residents of New York, Florida, California, or New Jersey at the time of their onsets of illness. Thirty-one (54%) of the 57 patients were male. Forty-four (77%) of the patients had PCP without KS; one (2%) had KS without PCP; two (4%) had both PCP and KS; and 10 (18%) had opportunistic infections without either PCP or KS. Twenty-nine percent of the pediatric patients are white; 50%, black; and 21%, of Hispanic origin. Of the 57 pediatric patients, 23 came from families in which one or both parents had a history of intravenous drug abuse; 13 had one or both parents who were born in Haiti; and 12 had transfusions with blood or blood components before their onsets of illness. Risk factor information on the parents of eight of the nine remaining patients is incomplete. Reported by State and Territorial Epidemiologists; AIDS Activity, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Nationally, the reported incidence of AIDS among adults continues to increase but at an apparently slower rate than in early 1983. Despite this increase, the proportion of adult patients outside of population groups previously identified as being at increased risk for AIDS has remained constant.

Most adult AIDS patients continue to be reported from among residents of a small number of states. It is unknown whether the decrease in the proportion of patients reported from New York and the increase in reporting from other states represents a true change in geographic distribution of patients or increased recognition and reporting of this syndrome in other states. Forty-one states, the District of Columbia, and Puerto Rico have either made AIDS reportable or have legislation pending to do so.

The geographic distribution of AIDS in children under 5 years old is similar to that seen for adult AIDS patients and is compatible with transmission from affected mothers before or at birth or transmission through blood transfusion. In both children and heterosexual adults, AIDS is much more likely to present with opportunistic infections than with KS.

References

1. CDC. Update: acquired immunodeficiency syndrome (AIDS)--United States. MMWR 1984;32:688-91.

2. Selik RM, Haverkos HW, Curran JW. Acquired immune deficiency syndrome (AIDS) trends in the United States, 1978-1982. Am J Med 1984;76:493-500.

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