To better monitor the
patterns of HIV diagnoses, all states have implemented HIV surveillance.
This report presents estimated numbers of cases of HIV/AIDS from the 35
areas (33 states, Guam, and the U.S. Virgin Islands) with integrated HIV
and AIDS surveillance since at least 2000. Two of these areas began
integrated surveillance in 2000: Guam and New York. New York is the
state with the highest reported percentage (18%) of cumulative national
AIDS cases, and inclusion of their integrated data resulted in large
numeric increases in the estimated number of HIV/AIDS cases compared to
previous HIV/AIDS surveillance reports. From 2001 through 2004, the
total number of new cases of HIV/AIDS in the 35 areas decreased
slightly; however, HIV/AIDS prevalence (i.e., the number of persons
living with HIV/AIDS) increased during this time: at the end of 2004, an
estimated 462,792 persons in the 35 areas were diagnosed and living with
HIV/AIDS. According to the number of reported AIDS cases, these 35 areas
represent approximately 61% of the epidemic in the United States. The
map on the cover depicts the estimated number of cases of HIV/AIDS in
2004, by area of residence at diagnosis, for persons residing in the 33
states with integrated HIV and AIDS surveillance.
Surveillance data on HIV infections provide a more complete picture of
the epidemic and the need for prevention and care services than does the
picture provided by AIDS data alone. However, the number of new HIV
diagnoses does not necessarily reflect trends in HIV incidence (i.e.,
new infections) because some newly diagnosed persons were
infected recently while others were infected some time in the past. One
method for estimating HIV incidence is to apply the serologic testing
algorithm for recent HIV seroconversion (STARHS) to the serum specimens
from which new HIV diagnoses were made. A total of 34 areas are using
this method to estimate population-based HIV incidence: 5 areas were
funded in FY 2002 to pilot this method, 19 areas were funded in FY 2003,
another 9 areas were funded in FY 2004 and one additional area was
funded in FY 2005. The monitoring of HIV incidence will be critical in
evaluating progress toward CDC’s HIV Prevention Strategic Plan goal of
reducing the number of new HIV infections in the United States from
40,000 to 20,000 per year, to allocate resources and evaluate prevention
program effectiveness.
In 2002, CDC initiated the Interstate Duplication Evaluation Project (IDEP),
a formal evaluation comparing HIV/AIDS records in the national database
across states in order to identify potential duplicate cases. Current
IDEP de-duplication efforts were completed in December 2004, and
approximately 40,000 HIV/AIDS cases were found to be duplicates
(representing less than 5% of almost 1 million cases that have been
reported to CDC over the course of the epidemic); these duplicate cases
have been removed from the national surveillance database and from
individual state surveillance databases. As a result of this correction
there may be minor reductions in reported cases displayed in this
surveillance report compared to the previous HIV/AIDS surveillance
report. The 2004 HIV/AIDS Surveillance Report presents data on cases
of HIV/AIDS. For analyses of HIV/AIDS data, we used data from 35 areas
(i.e., 33 states, Guam, and the U.S. Virgin Islands) with mature HIV
reporting systems (i.e., HIV reporting at least since 2000) to allow for
stabilization of data collection and for adjustment of the data in order
to monitor trends. Tables 1, 2, 8, and 9 summarize cases and prevalence
of HIV/AIDS. For analyses of AIDS cases, we used data from the 50
states, the District of Columbia, U.S. dependencies, possessions, and
associated nations.
This report is organized in 5 sections: (1) cases of HIV/AIDS and AIDS,
(2) deaths of persons with AIDS, (3) persons living with HIV/AIDS, AIDS,
or HIV infection (not AIDS), (4) length of survival after AIDS
diagnosis, and (5) reports of cases of AIDS, HIV infection (not AIDS),
and HIV/AIDS. In Sections 1–3, we present point estimates of case counts
that have been adjusted for reporting delays and for redistribution of
cases in persons initially reported without an identified risk factor.
CDC routinely adjusts data for the presentation of trends in the
epidemic. Data to estimate the number of cases of HIV/AIDS or AIDS; the
number of persons living with HIV/AIDS, AIDS, or HIV infection (not
AIDS); and the number of deaths among persons with AIDS have been
statistically adjusted to correct for delays in the reporting of cases
and deaths. To assess trends in cases, deaths, or prevalence, it is
preferable to use adjusted data, presented by year of diagnosis instead
of year of report, to eliminate artifacts of reporting in the
surveillance system. Therefore, for trends, the reader is encouraged to
use the tables in Sections 1–3 that present trends by year of diagnosis,
year of death, or year-end prevalence. Section 4 presents estimates of
survival for persons whose AIDS diagnosis was made during 2000 (Table
13) and for persons whose diagnosis was made during 1996–2003 (Figures
2–4). Proportions of persons who survived for various lengths of time
after diagnosis are presented by year of diagnosis, age group,
race/ethnicity, and HIV transmission category. Finally, Section 5
presents reports of cases of HIV infection (not AIDS) and cases of AIDS
reported through 2004. The areas included in tabulations of reported
cases of HIV infection (not AIDS) are based on the date that
confidential name-based HIV infection reporting was implemented. For
Tables 16, 18, 20, and 22, we used data from 42 areas to describe
reports of HIV infection. These data have not been adjusted for delays
in reporting and are presented by year of report to CDC. Tables that
present cases by year of report represent the most up-to-date
information reported to CDC; however, cases by year of report do not
represent incident cases, the most recent diagnoses, trends, or deaths.
Highlights of Analyses Cases of HIV/AIDS and cases of AIDS
Cases of HIV/AIDS The estimated number of HIV/AIDS cases in the 35 areas with confidential
name-based HIV infection reporting decreased year to year from 2001
through 2003 and then increased approximately 1% from the end of 2003
(38,139) through the end of 2004 (38,685).
- Age group: From 2001 through 2004, the estimated number of HIV/AIDS
cases decreased among children less than 13 years of age and in the
following age groups: 13–14, 30–34, 35–39, 40–44, and 45–49. The
estimated number of HIV/AIDS cases remained stable in the age group
25–29 years, and increased in the following age groups: 15–19, 20–24,
50–54, 55–59, 60–64, and 65 years and older. The largest number of
HIV/AIDS cases occurred among persons age 35–39 years and accounted for
17% of all HIV/AIDS cases diagnosed in 2004.
- Race/ethnicity: From 2001 through 2004, the estimated number of
HIV/AIDS cases increased among whites, Asians/Pacific Islanders, and
American Indians/Alaska Natives, and decreased among blacks and
Hispanics. Blacks accounted for 50% of all HIV/AIDS cases diagnosed in
2004.
- Sex: From 2001 through 2004, the estimated number of HIV/AIDS cases
decreased approximately 2% among males and 15% among females. In 2004,
males accounted for 73% of all HIV/AIDS cases among adults and
adolescents.
- Transmission category: From 2001 through 2004, the estimated number of
HIV/AIDS cases increased among men who have sex with men (MSM). The
estimated number of HIV/AIDS cases decreased among injection drug users
(IDUs), MSM who were also IDUs, heterosexual adults and adolescents, and
among children. MSM (47%) and persons exposed through heterosexual
contact (33%) accounted for 80% of all HIV/AIDS cases diagnosed in 2004.
Of all HIV infections diagnosed in 2003, 39% progressed to AIDS within
12 months after HIV infection was diagnosed. AIDS was diagnosed within
12 months after the diagnosis of HIV infection for a larger proportion
of persons aged 35 years and older, IDUs, and persons exposed through
heterosexual contact (Table 2).
Cases of AIDS
During 2000–2001, decreases in annual AIDS cases began to level;
however, after 2001, the estimated number of AIDS cases increased each
year (Table 3). In 2004, the estimated rate of AIDS cases in the United
States was 14.1 per 100,000 population (Table 5).
- Age group: From 2000 through 2004, the estimated number of AIDS cases
decreased 61% among children less than 13 years of age, 11% in the age
group 30–34, and 10% in the age group 35–39 years, and remained stable
in the age group 13–14 years (Table 3). The estimated number of AIDS
cases increased in the following age groups: 15–19, 20–24, 25–29, 40–44,
45–49, 50–54, 55–59, 60–64, and 65 years and older. The largest number
of AIDS cases occurred among persons age 40–44 years and accounted for
21% of all AIDS cases diagnosed in 2004.
- Race/ethnicity: From 2000 through 2004, the estimated number of AIDS
cases increased among all racial and ethnic groups (Table 3). In 2004,
rates of AIDS cases were 56.4 per 100,000 in the black population, 18.6
per 100,000 in the Hispanic population, 7.9 per 100,000 in the American
Indian/Alaska Native population, 6.0 in the white population, and 3.7
per 100,000 in the Asian/Pacific Islander population (Table 5).
- Sex: From 2000 through 2004, the estimated number of AIDS cases
increased 10% among females and 7% among males. Males accounted for 73%
of all AIDS cases diagnosed in 2004 among adults and adolescents in the
United States (Table 3). Rates of AIDS cases in 2004 were 25.6 per
100,000 among males and 9.0 per 100,000 among females (Table 5).
- Transmission category: From 2000 through 2004, the estimated number of
AIDS cases decreased among IDUs and among MSM who were also IDUs (Table
3). From 2000 through 2004, the estimated number of AIDS cases increased
among MSM. Among persons exposed through heterosexual contact, the
estimated number of AIDS cases increased each year from 2000 through
2004.
- Region: From 2000 through 2004, the estimated number of AIDS cases
increased 25% in the South and 13% in the Midwest, and decreased 8% in
the Northeast, 6% in the West, and 15% in the U.S. dependencies,
possessions, and associated nations.
Deaths
The estimated number of deaths among persons with AIDS decreased 8% from
2000 through 2004 (Table 7).
- Age group: From 2000 through 2004, the estimated number of deaths
decreased among children less than 13 years of age and in the following
age groups: 15–19, 25–29, 30–34, 35–39, 40–44, and 45–49. The estimated
number of deaths increased in the age groups 13–14, 20–24, 50–54, 55–59,
60–64, and 65 years and older.
- Race/ethnicity: From 2000 through 2004, the estimated number of deaths
among persons with AIDS decreased among whites, blacks, and
Asians/Pacific Islanders and increased among Hispanics and American
Indians/Alaska Natives.
- Sex and transmission category: From 2000 through 2004, among males,
the estimated number of deaths of MSM and IDUs decreased. Among females,
the estimated number of deaths of IDUs decreased. The estimated number
of deaths increased from 2000 through 2004 among adults and adolescents
of both sexes exposed through heterosexual contact.
- Region: The estimated number of deaths in 2004 compared with 2003
decreased in the Northeast and the Midwest; remained stable in the West
and increased in the South, and U.S. dependencies, possessions, and
associated nations.
Persons living with HIV/AIDS, HIV infection (not AIDS), or AIDS
Persons living with HIV/AIDS
The estimated number of persons living with HIV/AIDS has increased
steadily in the 35 areas with confidential name-based HIV infection
reporting (Table 8). At the end of 2004, an estimated 462,792 persons
were living with HIV/AIDS in the 35 areas with confidential name-based
HIV infection reporting since 2000:
- By age group, the most cases (22%) were in the age group 40–44 years.
- By race/ethnicity, 48% were black, 34% white, 17% Hispanic, and less
than 1% each were American Indian/Alaska Native and Asian/Pacific
Islander.
- By sex, 73% of adults and adolescents living with HIV/AIDS were male.
- Of the estimated 332,578 male adults and adolescents living with
HIV/AIDS, 60% were MSM, 19% were IDUs, 13% had been exposed through
heterosexual contact, and 7% were MSM who also were IDUs. Of the
estimated 123,405 female adults and adolescents living with HIV/AIDS,
71% had been exposed through heterosexual contact, and 27% had been
exposed through injection drug use. Of the estimated 6,804 children
living with HIV/AIDS, 90% had been exposed perinatally.
Prevalence rates of HIV infection (not AIDS)
In the 35 areas with confidential name-based HIV infection reporting,
the prevalence rate of HIV infection (not AIDS) among adults and
adolescents was estimated at 136.7 per 100,000 at the end of 2004 (Map
1). The rate for adults and adolescents living with HIV infection (not
AIDS) ranged from an estimated 15.0 per 100,000 (North Dakota) to an
estimated 281.7 per 100,000 (U.S. Virgin Islands). The prevalence rate
of HIV infection (not AIDS) among children residing in the 35 areas was
an estimated 7.9 per 100,000 at the end of 2004 (Map 2). The rate for
children living with HIV infection (not AIDS) ranged from an estimated
zero per 100,000 in New Mexico, North Dakota, and Guam, to an estimated
32.3 per 100,000 in New York.
Persons living with AIDS
AIDS prevalence has also increased steadily since 2000 (Table 10). At
the end of 2004, an estimated 415,193 persons in the United States were
living with AIDS:
- By age group, the most cases (23%) were in the age group 40–44 years.
- By race/ethnicity, 43% were black, 35% white, 20% Hispanic, 1%
Asian/Pacific Islander and less than 1% American Indian/Alaska Native.
- By sex, 77% of adults and adolescents living with AIDS were male.
- By region, 39% resided in the South, 29% in the Northeast, 19% in the
West, 10% in the Midwest, and 3% in the U.S. dependencies, possessions,
and associated nations.
- Of the estimated 317,698 male adults and adolescents living with AIDS,
58% were MSM, 21% were IDUs, 11% had been exposed through heterosexual
contact, and 8% were MSM who were also IDUs. Of the estimated 93,566
female adults and adolescents living with AIDS, 64% had been exposed
through heterosexual contact, and 34% had been exposed through injection
drug use.
AIDS prevalence rates
In the United States, the prevalence rate of AIDS among adults and
adolescents was estimated at 168.8 per 100,000 at the end of 2004 (Map
1). The rate for adults and adolescents living with AIDS ranged from an
estimated 4 per 100,000 (U.S. Pacific Islands) to an estimated 1,906 per
100,000 (District of Columbia). The prevalence rate of AIDS among
children in the United States was estimated at 3.2 per 100,000 at the
end of 2004 (Map 2). The rate for children living with AIDS ranged from
an estimated zero per 100,000 in Guam, Idaho, Montana, Utah, and the
U.S. Pacific Islands to an estimated 52.8 per 100,000 in the District of
Columbia.
Survival after AIDS diagnosis
Table 13 is limited to data on AIDS cases diagnosed in 2000 in order to
describe the survival of persons whose diagnosis was made relatively
recently, but far enough in the past to permit a meaningful measure of
survival. Figures 2, 3, and 4 illustrate the proportion of surviving
persons among persons whose diagnoses were made over a longer period,
1996 through 2003.
- Survival (the estimated proportion of persons surviving a given length
of time after diagnosis) increased with the year of diagnosis for
diagnoses made during 1996–1999. Year-to-year differences were small
during 1999–2003 (Figure 2).
- Survival decreased as age at diagnosis increased among persons at
least 35 years old at diagnosis and in comparison with persons younger
than 35. Survival was similar for the age groups 13–24 and 25–34.
Survival was greatest among children less than 13 years of age at
diagnosis (Figure 3).
- Survival was greatest among MSM and among children with perinatally
acquired HIV infection (Table 13). Survival was intermediate among men
and women who had heterosexual contact with someone known to be HIV
infected or at high risk for HIV infection, as well as among MSM who
also were IDUs. Survival was lowest among men and women who were IDUs.
- Survival, particularly at more than 48 months after diagnosis, was
greater among Asians/Pacific Islanders, whites, and Hispanics, than
among blacks (Figure 4). Results were unstable or inconsistent for
American Indians/Alaska Natives because the numbers of persons in this
racial/ethnic category were small.
Reports of Cases of AIDS, HIV infection (not AIDS), and HIV/AIDS
Tables 14–23 describe reports of cases of AIDS, HIV infection (not
AIDS), and of HIV/AIDS. Tables 16, 18, 20, and 22 are based on reports
of cases of HIV infection (not AIDS) through 2004 from the 42 areas that
had implemented name-based HIV infection reporting. Note that not all
cases of HIV infection (not AIDS) or AIDS reported in 2004 reflected new
diagnoses; rather, the reported cases include cases diagnosed during
earlier years.
Reports of cases of HIV infection (not AIDS)
Through 2004, a total of 229,411 persons were reported as having HIV
infection (not AIDS) in the 42 areas with confidential name-based HIV
infection reporting (Table 16). Five states (New York, Florida, Texas,
New Jersey, and North Carolina) reported 121,787 (53%) of the 229,411
cumulative cases of HIV infection (not AIDS) reported to CDC. In 2004, 3
states (New York, Florida, and Texas) reported 15,283 (46%) of the
33,563 cases of HIV infection (not AIDS).
- By sex, in 2004, 70% of the 33,132 reported cases of HIV infection
(not AIDS) among adults and adolescents were in males, and 30% were in
females (Table 18).
- In 2004, 431 cases of HIV infection (not AIDS) in children were
reported.
Reports of AIDS cases
Through 2004, a total of 918,286 persons had been reported as having
AIDS in the United States, dependencies, possessions, and associated
nations (Table 14). Three states (California, Florida, and New York)
reported 43% of the cumulative AIDS cases, and 41% of AIDS cases
reported to CDC in 2004. In the United States, the rate of reported AIDS
cases in 2004 was 15.0 per 100,000 population. The rate of reported AIDS
cases ranged from zero per 100,000 (U.S. Pacific Islands) to 179.2 per
100,000 (District of Columbia).
- By sex, in 2004, males accounted for 73% and females for 27% of 44,615
reported AIDS cases among adults and adolescents (Table 17).
- In 2004, 122 AIDS cases in children were reported.
Additional Resources
The following were prepared by using HIV/AIDS surveillance data:
Suggested Readings
CDC.
Advancing HIV prevention: new strategies for a changing
epidemic―United States, 2003. MMWR 2003;52:329-332.
CDC.
Diagnosis and reporting of HIV and AIDS in 25 states―United States,
1994–2000. MMWR 2002;51:595-598.
CDC.
Guidelines for national HIV case surveillance, including monitoring
for HIV infection and AIDS. MMWR 1999;48(No. RR-13):1-31.
CDC.
HIV Prevention Strategic Plan Through 2005.
Atlanta: U.S. Department of Health and Human Services, CDC; 2001.
CDC.
Increases in HIV diagnoses—29 states, 1999–2002. MMWR
2003;52:1145-1148.
CDC.
Update: the AIDS epidemic in the United States, 2001. MMWR
2002;51:592-595.
Janssen RS, Satten GA, Stramer SL, et al. New testing strategy to detect
early HIV-1 infection for use in incidence estimates and for clinical
and prevention purposes. JAMA 1998;280:42-48.
Karon JM, Fleming PL, Steketee RW, De Cock KM. HIV in the United States
at the turn of the century: an epidemic in transition. Am J Public
Health 2001;91:1060-1068.
Nakashima AK, Fleming PL. HIV/AIDS surveillance in the United States,
1981–2001. J Acquir Immune Defic Syndr 2003;32:68-85.
CDC.
Diagnoses of HIV/AIDS—32 states, 2000–2003. MMWR
2004;53:1106-1110.
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