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

As of November 26, 1984, physicians and health departments in the United States had reported 6,993 patients meeting the surveillance definition for acquired immunodeficiency syndrome (1,2). Over 86% of the adult AIDS patients and 82% of the pediatric patients have been reported since January 1983 (Figure 1). Three thousand three hundred forty-two (48%) of all reported patients are known to have died (48% of the adults and 69% of the children), including 73% of patients diagnosed before January 1983.

Adult Patients: Among 6,921 adult AIDS patients, 59% of cases have occurred among whites; 25%, among blacks; 14%, among persons of Hispanic origin; and 2%, among persons of other or unknown race/ethnicity. Seventy-five percent of the adults were reported to be residents of New York, California, Florida, or New Jersey, with the remainder reported from 41 other states, the District of Columbia, and Puerto Rico. Identified risk groups of adult AIDS patients and trends for each group are shown in Table 1. Among the 54 AIDS patients who were heterosexual sex partners of persons with AIDS or with an increased risk for acquiring AIDS, 49 (91%) were women.

Of the adult AIDS patients, 263 (4%) have not been placed in any of the identified risk groups and are classified as noncharacteristic patients. One hundred eighty-six (71%) of the noncharacteristic patients were male; 34%, white; 43%, black; and 19%, of Hispanic origin. Investigations of 65 of the male noncharacteristic patients have identified 17 (26%) who reported a history of sexual contact with female prostitutes. Five of the 17 gave a history of over 100 heterosexual partners in the past 5 years. Seven were Hispanic; five, black; four, white; and one, Asian. Thirteen had Pneumocystis carinii pneumonia (PCP); three had Kaposi's sarcoma (KS); and one had another opportunistic disease. One of the nine noncharacteristic women interviewed claimed to be a former prostitute.

Pediatric Patients: Of 72 patients under 13 years of age, 81% were reported to be residents of New York, California, Florida, or New Jersey, with the remainder reported from nine other states. Forty-two (58%) of the 72 patients were male. Fifty (69%) had PCP without KS; four (6%) had KS without PCP; two (3%) had both PCP and KS; and 16 (22%) had another opportunistic disease without either PCP or KS. Twenty-five percent of the pediatric patients are white; 54%, black; and 19%, of Hispanic origin. Twenty-nine (40%) of the 72 pediatric patients came from families in which one or both parents had histories of intravenous (IV) drug abuse; 17 had one or both parents who were born in Haiti; 12 had received blood or blood components before their onsets of illness; four had hemophilia; one had a father who was bisexual; and one child's parents deny any risk factors. Risk-factor information on the parents of the eight remaining patients is incomplete.

Eighty-one adults (1% of adult patients) and 12 children (17% of pediatric patients) with transfusion-associated AIDS (TA-AIDS) have no other risk factors and were transfused with blood or blood components within 5 years of illness onset. TA-AIDS patients received blood from one to 75 donors (median 16 donors); interval from tranfusion to diagnosis was 4 months to 62 months (median 29 months for adults, 14 months for children). Median age at diagnosis of AIDS was 53 years for adults (range 19-81 years) and 14 months for children (range 4-46 months). Most adults received transfusions associated with surgery, while most infants with TA-AIDS were transfused for medical problems associated with prematurity (3). Reported by State and Territorial Epidemiologists; AIDS Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Throughout 1984, the number of AIDS cases reported increased 74% compared to the same period of 1983. Forty-two states, the District of Columbia, and Puerto Rico now require reporting of AIDS cases to health departments. Although 45 states have reported cases, the majority of adult AIDS patients continues to be reported from a small number of states. The geographic distribution of AIDS among children with parents in high-risk groups is similar to that seen for heterosexual adult AIDS patients; over 89% are from New York, California, New Jersey, and Florida. In both children and heterosexual adults, AIDS is much more likely to present with PCP and other opportunistic infections than with KS. Although the number of AIDS cases being reported continues to increase in all patient groups, the rate of increase among Haitian AIDS patients is significantly less (p 0.001) than among the remaining groups.

The proportion of adult patients outside identified risk groups for AIDS has remained stable. AIDS patients classified as noncharacteristic are a heterogenous group. For example, some patients, such as 11 with KS and normal immunologic studies, may not have AIDS, even though they meet the surveillance definition. For other patients, information concerning risk factors is incomplete. Still other noncharacteristic patients may have unknowingly been the sexual partners of risk-group members (4).

Heterosexual transmission of AIDS has been reported in both the United States and Africa (5-9). In the United States, such transmission has been uncommon. When heterosexual transmission has occurred, it has primarily been from men, particularly male IV drug users, to their female partners. However, in several African countries, heterosexual transmission appears to be the predominant mode in the spread of AIDS. In Zaire, where the male-to-female ratio of AIDS cases has been reported to be 1.1 to 1, transmission from women to men may be more common than in the United States (8). Furthermore, among 24 adults diagnosed as having AIDS in Rwanda, 12 of the 17 men were reported to have had contact with prostitutes, and three of the seven women were prostitutes (9).

The importance of female-to-male transmission in the spread of AIDS in the United States and the role, if any, of female prostitutes in this transmission have not been established. Women, including female prostitutes, could be exposed to the AIDS virus through sexual contact, use of IV drugs, or transfusion. However, the number of these women presently infected is likely to be small. It is not known if such women would be as efficient as heterosexual or homosexual men in transmitting the AIDS virus. Future studies will attempt to clarify and quantify the risks of female-to-male transmission and contact with prostitutes.

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.

3. Curran JW, Lawrence DN, Jaffe HW, et al. Acquired immunodeficiency syndrome (AIDS) associated with transfusions. N Engl J Med 1984;310:69-75.

4. Chamberland ME, Castro KG, Haverkos HW, et al. Acquired immunodeficiency syndrome in the United States: an analysis of cases outside high-incidence groups. Ann Intern Med 1984;100:617-23.

5. CDC. Immunodeficiency among female sexual partners of males with acquired immune deficiency syndrome (AIDS)--New York. MMWR 1983;31:697-8.

6. Harris C, Small CB, Klein RS, et al. Immunodeficiency in female sexual partners of men with the acquired immunodeficiency syndrome. N Engl J Med 1983;308:1181-4.

7. Pitchenik AE, Fischl MA, Spira TJ. Acquired immune deficiency syndrome in low-risk patients. Evidence for possible transmission by an asymptomatic carrier. JAMA 1983;205:1310-2.

8. Piot P, Quinn TC, Taelman H, et al. Acquired immunodeficiency syndrome in a heterosexual population in Zaire. Lancet 1984;II:65-9.

9. Van de Perre P, Rouvroy D, Lepage P, et al. Acquired immunodeficiency syndrome in Rwanda. Lancet 1984;II:62-5.

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