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HIV incidence in the United States: patterns and temporal trends, 1978-1999.
Journal of Acquired Immune Deficiency Syndromes 2002;31(2):188-201.
Vu MQ, Steketee RW, Valleroy L, Weinstock H, Karon J, Janssen R.
Abstract
CONTEXT: HIV incidence measurements, which reflect recent or current transmission,
are valuable for monitoring the epidemic and evaluating prevention programs.
OBJECTIVES: To summarize HIV incidence patterns and trends in U.S. population
groups. DATA SOURCES: Publications in English from 1980 through mid-2000.
STUDY SELECTION AND STATISTICAL METHODS: We searched the literature for reports
of HIV incidence in the United States. Locally weighted scatterplot smoothing
was used to generate smooth curves to estimate trends in incidence. Spearman
rank correlation was used to estimate the correlation coefficient between
prevalence and incidence. DATA SYNTHESIS: In 74 eligible reports, HIV incidence
varied widely (0.002-19.8 per 100 person-years [py]) depending on risk group.
Among men who have sex with men (MSM), HIV incidence peaked in the early
1980s (5-20/100 py) and then declined but remained high during the 1990s
(2-4/100 py). Among injection drug users (IDUs), incidence decreased since
the mid-1980s but differed by geographic area; in the 1990s, incidence remained
high in the East (1-3/100 py) but was lower in the West (<0.5/100 py).
Throughout the late 1980s and 1990s, incidence was low and stable in broader
populations (blood donors: <0.01/100 py; military personnel: 0.01-0.07/100
py). The correlation between HIV incidence and prevalence was strong in populations
with a prevalence less than 1% (r = 0.94, p<.0001), moderate in populations
with a prevalence from 1% to less than 10% (r = 0.57, p<.0001), and weak
in populations with a prevalence at least 10% (r = 0.23, p=.09). CONCLUSIONS:
HIV prevention in the United States should continue to focus on MSM and IDUs.
HIV incidence measurements should be considered for monitoring HIV transmission
in MSM, IDUs, and other populations in which seroprevalence is high.