CDC and Journal of the American Medical Association Confirms New HIV Estimates

Jim Burroway

August 4th, 2008

The big news this morning is that the CDC has confirmed its latest estimates of HIV incidence in the United States. Regular longtime readers at Box Turtle Bulletin may remember that these new figures were first discussed last November, with a follow-up in March.

At the time, the CDC were emphatic that the higher number of HIV cases reported “do not represent an increase in the epidemic.” Instead, the higher numbers were due to an improved surveillance system and blood tests. The CDC also said they were awaiting a professional peer review in a major medical journal.

The Journal of the American Medical Association yesterday released the results of that peer review and validated the new estimate. Among the Journal’s findings:

An estimated 39,400 persons were diagnosed with HIV in 2006 in the 22 states. Of 6864 diagnostic specimens tested using the BED assay, 2133 (31%) were classified as recent infections. Based on extrapolations from these data, the estimated number of new infections for the United States in 2006 was 56,300 (95% confidence interval [CI], 48,200-64,500); the estimated incidence rate was 22.8 per 100,000 population (95% CI, 19.5-26.1). Forty-five percent of infections were among black individuals and 53% among men who have sex with men. The back-calculation (n = 1.230 million HIV/AIDS cases reported by the end of 2006) yielded an estimate of 55,400 (95% CI, 50 000-60 800) new infections per year for 2003-2006 and indicated that HIV incidence increased in the mid-1990s, then slightly declined after 1999 and has been stable thereafter.

The CDC emphasizes again:

It should be noted that the new incidence estimate does not represent an actual increase in the numbers of HIV infections. Rather, a separate CDC historical trend analysis published as part of this study suggests that the annual number of new infections was never as low as 40,000 and that it has been roughly stable since the late 1990s (with estimates ranging between 55,000 and 58,500 during the three most recent time periods analyzed).

This is important to remember. This is not a sudden increase in HIV infections, but it does mean that the problem was considerably larger than previously understood. HIV Infection is the precursor to AIDS itself, with the infection often occurring 6-12 years before the onset of AIDS. AID diagnoses have actually been falling slightly throughout the past decade, which is consistent with the CDC’s finding that HIV infections have been relatively steady since 1999.

Blondie Writes

August 4th, 2008

Very informative article. But there are so many people that have HIV that are not gay and people want you to beleive that only gays have HIV.

John Howard

August 4th, 2008

Sounds like they are making that up about better reporting accounting for the increase. Why aren’t there hard numbers to report, based on real patients getting positive HIV tests? Are they saying that lots of people got false negative tests back then? What is the basis to make such a claim?

Jim Burroway

August 4th, 2008

I don’t know how test methods play into this. I suspect the change has more to do with how they make their estimates, which I went into here last November.

AIDS diagnoses is reportable to the CDC, but HIV+ test results are not necessarily reported. You can now get tested pretty much anywhere, not just in a clinical setting. You can even take a home HIV test. Also, the CDC is trying to get a handle on estimating the number of people who are HIV+ but who haven’t been tested. All this makes an accurate count of everyone who is HIV+ impossible. Hence the estimates.

Jim Burroway

August 4th, 2008

Here’s something else to answer your question. This is from the JAMA article:

The development of laboratory assays that differentiate recent vs longstanding HIV infections now makes it possible to directly measure HIV incidence.

In other words, when you get tested for HIV, the test itself can tell if you were recently infected or if you’ve been infected for several years.

John Howard

August 4th, 2008

thanks for those answers. Another thing I was wondering, does the CDC know if the percentage of “men who have sex with men” is increasing, or what that percentage is?

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