# Presentation: 658501

## HIV

**HIV**
**Progress Review**
**August 4, 2003**

**Notes:**
 Lead agencies are HRSA and CDC
 Substituting for Dr. Sondik
 Acknowledge contribution of workgroup 

## Healthy People 2010 HIV Objectives

_**HIV/AIDS incidence & deaths**_
**13-01****	****New AIDS cases**
**13-02****	****New AIDS cases among men who have sex with men**
**13-03****	****New AIDS cases among persons who inject drugs**
**13-04****	****New AIDS cases among men who have sex with men & inject drugs**
**13-05     New HIV cases**
**13-14****	****Deaths due to HIV infection**
**13-17****	****Perinatally-acquired HIV infection cases**

***       ***

**Notes:**
 Blue = measurable
 Red = developmental; baseline data secured; target not set (pending SC approval)
 Gray = developmental; no baseline data 

## Healthy People 2010 HIV Objectives

***       ***

_**Prevention, testing, & treatment**_
**13-06****	****Condom use at last intercourse**
**13-07 ****	****HIV-positive persons who know their serostatus**
**13-08****	****Substance abuse treatment facilities that offer HIV/AIDS counseling, ****	****education and support to clients**
**13-09 ****	****State prison systems that provide HIV/AIDS, STD, and TB education**
**13-10 ****	****State prison inmates who receive HIV counseling and testing**
**13-11****	****Adults with TB who have been tested for HIV**
**13-12****	****Screening for STDs and immunization for hepatitis B at HIV**
** ****	****counseling and testing sites**
**13-13    ****	****HIV-infected persons who are treated according to PHS guidelines**
**13-15****	****HIV cases diagnosed **_**>**_** 1 month before AIDS diagnosis**
**13-16****	****AIDS cases that die within 12 months of AIDS diagnosis**

**Healthy People 2010 HIV Objectives**

**Notes:**
 Blue = measurable
 Red = developmental; baseline data secured; target not set (pending SC approval)
 Gray = developmental; no baseline data 

## Public Health Impact of HIV/AIDS 

**in the United States**

- SOURCES: CDC/NCHSTP and CDC/NCHS.

**HIV (Estimated)**

**AIDS**

**  **
**   ****Persons newly infected with HIV each year:  40,000 **
**   ****Persons living with HIV (as of 2000):  850,000 – 950,000**
**   ****Of those persons living with HIV,  180,000 – 280,000 (19-33%) do not know  **
**    ****that they are infected    **
**            **

**  **
**   ****New AIDS cases in 2001:  43,158**
**   ****Cumulative AIDS cases reported to CDC (as of 12/2001):  816,149**

**Notes:**
(Describe slide)

## Public Health Impact of HIV/AIDS 

- SOURCES: CDC/NCHSTP; CDC/NCHS; and Holtgrave DR and Pinkerton, SD. Updates of Cost of Illness and Quality of Life Estimates for Use in Economic
- Evaluations of HIV Prevention Programs. J Acquir Immune Defic Syndr Hum Retrovirol: Volume 16(1). September 1, 1997. 54-62

**HIV/AIDS Treatment Costs (Estimated)**

**Deaths from HIV/AIDS**

**   ****Number of deaths**** due to HIV/AIDS (2001):  14,175**
**   ****Cumulative deaths in persons with AIDS (as of 12/2001):  467,910**

** **
**  ****Lifetime treatment cost:  $155,000 per person **

**Public Health Impact of HIV/AIDS **
**in the United States**

**Notes:**
(Describe slide)

## Trends in AIDS Incidence, Prevalence, 

**Year of diagnosis**

**Incidence**

**Deaths**

**Prevalence**

**Number of cases/deaths**
**(thousands)**

**Prevalence**
**(thousands)**

**1993 definition**
**implementation**

**Trends in AIDS Incidence, Prevalence, **
**and Deaths, 1981 – 2002***

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**81**

**83**

**85**

**87**

**89**

**91**

**93**

**95**

**97**

**99**

**01**

- *Data for 2002 are preliminary.

**Notes:**
  Three phases
  Steep decline in AIDS incidence/mortality in the mid- to late 1990s due to the introduction of highly effective treatments + estimated decline in HIV incidence
  Level off in recent years
  Preliminary data show a 2.2% increase in AIDS incidence from 2001 to 2002

## 13-5. New HIV Cases (25 States)

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE: Data are for persons 13 years and over.  Objective is developmental.  A 2010 target has not been set.

**Number of new cases**

**1998**

**1999**

**2001**

**2000**

**Year of diagnosis**

**Notes:**
 These are actual HIV cases from a new surveillance system
  Currently, the system includes 25 States that have had confidential, name-based HIV reporting since 1994 
  All States (except GA) have begun HIV surveillance.  GA will come on board soon.
o  More States will be included in the reporting in the next few years 

 Only tested cases are captured

## HIV Diagnoses, by Mode of Exposure 

- MSM

- MSM/IDU

- IDU

- Heterosexual contact

**HIV Diagnoses, by Mode of Exposure **
**(25 States) **

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Year of diagnosis**

**HIV diagnoses**

**Notes:**
(Describe slide)

## *

**Percent**** **

**Most recent level**

**2010 target**

**Direction desired**

**Substance abuse treatment**
**facilities offering **
**HIV/AIDS counseling**
**(Obj. 13-8)**

**Adults 25-44 years with TB **
**who have been tested for HIV**
**(Obj. 13-11)**

-  SOURCE:  HIV/AIDS Reporting System, CDC/NCHSTP (13-7); N-SSATS, SAMHSA (13-8); National TB Surveillance System, CDC/DTBE (13-11).

**75%**
**(2000)**

**55%**
**(2002)**

**70%**

**85%**

**Status of Selected Objectives**

**HIV-positive persons **_**>**_** 13 years **
**who know their serostatus**
**(Obj. 13-7)**

- Developmental objective.  Target has not been set.

**58%**
**(2001)**

**Notes:**
(Describe slide)

  13-7: Number of HIV-positive persons (ages 13+) who know their serostatus is a modeled estimate (not actual number).    

## 13-1. Distribution of New AIDS Cases

**by Race/Ethnicity, 1985 - 2001**

**1987**

**1985**

**1989**

**1991**

**1993**

**1995**

**1997**

**1999**

**2001**

**0**

**10**

**20**

**30**

**40**

**50**

**60**

**70**

**Year of Report**

- Black, not Hispanic

- Hispanic

- White, not Hispanic

**Percent of Cases**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE: Less than 1% of new AIDS cases were reported in Asian/Pacific Islanders and American Indian/Alaska Natives during this time period.

**Notes:**
(Describe slide) 

## 13-1. Distribution of New AIDS Cases

**by Race/Ethnicity**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

- NOTE: “Other” includes Asian/Pacific Islanders and American Indian/Alaska Natives.

**2001**

**1985**

**Black, not Hispanic**

**White, not Hispanic**

**Hispanic**

**Other**

**15%**

**25%**

**60%**

**<1%**

**49%**

**31%**

**19%**

**1%**

**Notes:**
(Describe slide)

## AIDS in Adolescents and Adults, 

- N=408

- N=1,575

- N=41,809

**20-24 years**

**50%**

**50%**

**63%**

**37%**

**75%**

**25%**

- Male

- Female

**AIDS in Adolescents and Adults, **
**by Sex and Age at Diagnosis, Reported in 2002**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Notes:**
(Describe slide)

## 13-2 – 13-4. Distribution of New AIDS Cases 

**by Mode of Exposure**

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Females**

**Males**

**Men who have sex with men (MSM)**

**MSM & IDU**

**Injection drug use (IDU)**

**Heterosexual contact**

**Other/Unknown**

**70%**

**10%**

**4%**

**16%**

**<1%**

**41%**

**1985**

**2001**

**1985**

**2001**

**54%**

**6%**

**1%**

**24%**

**15%**

**27%**

**55%**

**18%**

**32%**

**65%**

**3%**

**Notes:**
(Describe slide)

## Perinatally-Acquired AIDS Cases 

- SOURCE: HIV/AIDS Reporting System, CDC/NCHSTP.

**Year of diagnosis**

**Number of cases**

**Notes:**
 Success story
 1992-1998: 75% decline 
 Trend is similar to all AIDS incidence but a more dramatic decline
 Decline attributed to PHS recommendation issued in 1994-1995 to voluntarily test pregnant women for HIV and offer AZT to mother and infant (after birth)
 Current strategy: Universal testing of all pregnant women 

## 13-13. Antiretroviral Treatment

- SOURCE: ASD, CDC/NCHSTP.

- NOTE: Data are for persons 13 years and over.  Data are from over 100 clinical sites in 11 U.S. cities.

**Percent**** **

**1999**

**2001**

**2010 target**

**Any antiretroviral therapy                (Obj. 13-13c)**

**Highly active antiretroviral therapy (HAART)  **
**(Obj. 13-13d)**

**1997**

**Notes:**
 These data are for the HIV-positive population that is in the system of care (not for the entire HIV-positive population)
 Increase in % receiving any retroviral therapy is driven by increase in % receiving HAART
 The percentages shown should not necessarily be interpreted as being low – some people do not need these treatments

## 13-14. Deaths Due to HIV/AIDS, 2001*

**13-14. Deaths Due to HIV/AIDS, 2001***

- SOURCE: NVSS-M, CDC/NCHS.                                                                                                                                                                   * Data are preliminary

**Age-adjusted death rate per 100,000 standard population**

**2010 target**

**Notes:**
(Describe slide)  
 2001 data are preliminary. 

## 13-14. Distribution of Deaths Due to 

**HIV/AIDS by Race/Ethnicity**

- SOURCE: NVSS-M, CDC/NCHS.                                                                                                                                                                 * Data are preliminary

**1990**

**2001***

- NOTE: “Other” includes Asian/Pacific Islanders and American Indian/Alaska Natives.

**Black, not Hispanic**

**White, not Hispanic**

**Hispanic**

**Other**

**60%**

**29%**

**10%**

**<1%**

**54%**

**30%**

**13%**

**3%**

**Notes:**
(Describe slide)

## 13-14. Deaths Due to HIV/AIDS, 2000

- SOURCE: NVSS-M, CDC/NCHS.                                                               			                * Based on fewer than 20 deaths.

**5.4 – 12.1      **
**2.5 – 5.3        **
**0.8 – 2.4**
**Unreliable***

**Age-adjusted rate per 100,000****        **

**     ****N**

**(12)**
**(14)**
**(14)**
**(10)**

**D.C. (45.3)**

## HIV as a Leading Cause of Death, 2000

- SOURCE: NVSS-M, CDC/NCHS.  ICD codes: B20 – B24.

**Notes:**
 CURRENTLY – 2000 (ALL AGES):
HIV ranks 18th
Behind...
	Parkinson’s Disease
	Aortic Aneurysm

PEAK YEARS – 1992 – 1996 (ALL AGES)
HIV ranked 8th
Ahead of...
	Suicide
	Chronic liver disease and cirrhosis 
In 1995, ~ 43,000 deaths
In 2001, ~ 15,000 deaths

  HIV is the # 1 leading cause of death for Black, not Hispanic persons aged
   25-44 years 

## Progress review data and slides

**Progress review data and slides**
**can be found on the web at:**

- http://www.cdc.gov/nchs/hphome.htm

**Notes:**
  These slides & the briefing book materials are available on the NCHS healthy people home page