Incidence Rate Of Acquired Immunodeficiency Syndrome Research Articles

Changes in the incidence and prevalence of human immunodeficiency virus or acquired immunodeficiency syndrome in the South African medical schemes environment: 2005-2015.

BackgroundThe South African (SA) private medical schemes environment has over the past two decades respond to the evolving needs of people living with the human immunodeficiency virus (PLWH) or acquired immunodeficiency syndrome (AIDS).ObjectiveTo determine changes in the incidence and prevalence rate of human immunodeficiency virus (HIV) or AIDS in the SA private medical schemes environment from 2005 to 2015.MethodIn this observational study, a single, pharmaceutical benefit management (PBM) company’s medicine-claims database of members with HIV or AIDS has been retrospectively analysed from January 2005 to December 2015. The cohort includes all patients identified by the HIV or AIDS-related diagnostic ICD-10 codes, B20-B24, who also claimed antiretroviral medication during that period.ResultsFrom 2005 to 2015, the proportion of HIV or AIDS patients enrolled in the PBM-company increased from 0.63% to 2.10%, and the incidence rate of new cases among the beneficiaries increased 2.3 times. The highest HIV or AIDS prevalence and incidence rates were found in the age group ≥ 40 and < 60 years, followed by the age group ≥ 60 and < 70 years. The highest prevalence rates in 2015 were recorded in Gauteng, namely, 422.4/1000 beneficiaries, followed by Western Cape (149.4/1000), and KwaZulu-Natal (118.4/1000).ConclusionThere has been an increase in the number of SA-PLWH accessing treatment in the medical scheme environment. The high prevalence of HIV infection among older members should signal concern that HIV-related comorbid conditions are likely to become a growing component of care required by PLWH utilizing the SA private healthcare sector.

Epidemiološka situacija HIV/AIDS-a među muškarcima i ženama u Srbiji za period 2007-2017. godine - joinpoint regresiona analiza

Introduction: Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) is a global major health problem. According to the data for 2018, there were 37.9 million people living with HIV/AIDS in the world, and the number of deaths related to AIDS was about 770,000. Aim: The aim of this study was to analyze the trend of newly diagnosed HIV-infected people, AIDS patients and AIDS-related deaths among men and women in Serbia, for the period 2007-2017. Materials and methods: Data on newly diagnosed HIV-infected people, AIDS patients and AIDS-related deaths were taken from the Report on Infectious Diseases in the Republic of Serbia. Age-specific and standardized mortality and incidence rates (standardized according to the world population) were calculated based on the data obtained. Joinpoint regression analysis was used to examine the trend. Results: The average standardized rates of newly diagnosed HIV-infected people (per 100,000) in Serbia, for the period 2007-2017, were 3.4 for men and 0.8 for women. There was a significant annual increase in standardized rates of newly diagnosed HIV-infected people; 7.0% for men and 21.1% for women. The average standardized rates (per 100,000) of AIDS incidence were 0.9 for men and 0.2 for women. There was a significant annual increase of 4.9% in the standardized incidence rate of AIDS in men, and a significant decrease of -12.2% in women. The average standardized mortality rates from AIDS (per 100,000) were 0.4 for men and 0.1 for women. During the observation period, there were no significant changes in the standardized mortality rates from AIDS in men, while in women there was a significant decline of -13.9% per year. The most common route of HIV transmission in men was sexual intercourse with men (69.0%), and in women it was heterosexual intercourse (75.7%). Conclusion: Further work is needed, primarily in advancing preventive measures, particularly by educating young people about transmission pathways and risks, but also in the early detection of HIV-infected persons and timely treatment.

Integration of Antiretroviral Therapy with Tuberculosis Treatment

We previously reported that integrating antiretroviral therapy (ART) with tuberculosis treatment reduces mortality. However, the timing for the initiation of ART during tuberculosis treatment remains unresolved. We conducted a three-group, open-label, randomized, controlled trial in South Africa involving 642 ambulatory patients, all with tuberculosis (confirmed by a positive sputum smear for acid-fast bacilli), human immunodeficiency virus infection, and a CD4+ T-cell count of less than 500 per cubic millimeter. Findings in the earlier-ART group (ART initiated within 4 weeks after the start of tuberculosis treatment, 214 patients) and later-ART group (ART initiated during the first 4 weeks of the continuation phase of tuberculosis treatment, 215 patients) are presented here. At baseline, the median CD4+ T-cell count was 150 per cubic millimeter, and the median viral load was 161,000 copies per milliliter, with no significant differences between the two groups. The incidence rate of the acquired immunodeficiency syndrome (AIDS) or death was 6.9 cases per 100 person-years in the earlier-ART group (18 cases) as compared with 7.8 per 100 person-years in the later-ART group (19 cases) (incidence-rate ratio, 0.89; 95% confidence interval [CI], 0.44 to 1.79; P=0.73). However, among patients with CD4+ T-cell counts of less than 50 per cubic millimeter, the incidence rates of AIDS or death were 8.5 and 26.3 cases per 100 person-years, respectively (incidence-rate ratio, 0.32; 95% CI, 0.07 to 1.13; P=0.06). The incidence rates of the immune reconstitution inflammatory syndrome (IRIS) were 20.1 and 7.7 cases per 100 person-years, respectively (incidence-rate ratio, 2.62; 95% CI, 1.48 to 4.82; P<0.001). Adverse events requiring a switching of antiretroviral drugs occurred in 10 patients in the earlier-ART group and 1 patient in the later-ART group (P=0.006). Early initiation of ART in patients with CD4+ T-cell counts of less than 50 per cubic millimeter increased AIDS-free survival. Deferral of the initiation of ART to the first 4 weeks of the continuation phase of tuberculosis therapy in those with higher CD4+ T-cell counts reduced the risks of IRIS and other adverse events related to ART without increasing the risk of AIDS or death. (Funded by the U.S. President's Emergency Plan for AIDS Relief and others; SAPIT ClinicalTrials.gov number, NCT00398996.).

AIDS Morbidity and Mortality in Brazilian Children Before and After Highly Active Antiretroviral Treatment Implementation

The objective of this study was to analyze regional trends over time of acquired immunodeficiency syndrome (AIDS) cases and deaths in Brazilian children, before and after implementation of free access to highly active antiretroviral treatment (HAART). We performed a nation-wide study with an ecologic design and a time-series analysis of AIDS incidence and mortality rates in children (0-12 years of age), using polynomial regression models. Data were obtained from official national databases on age group, residence region, and year of AIDS diagnosis and death (1984-2008). Between 1984 and 2008, 14,314 (2.7%) AIDS cases and 5041 deaths (2.3% of all AIDS-related deaths) were reported in Brazilian children. Incidence after 1996 was reduced by 23%, as compared with the pre-HAART era. The mortality rate observed in the HAART era was reduced by 63.6%. There was a significant reduction in the incidence in the Southeast and Central-West regions (P < 0.001), but the less industrialized North region showed an increase in the pre-HAART era (P < 0.001), and the Northeast region showed a stabilization trend (P < 0.001). In the South region, the incidence of AIDS increased in the 0 to 4 years subgroup. A reduction of AIDS mortality in the Southeast (P < 0.001), South, and Central-West regions (P < 0.001) was seen, but the Northeast and North regions maintained an increasing mortality trend (P < 0.001). Despite the overall reduction in AIDS-related cases and deaths among children in Brazil since HAART, marked regional differences continue to exist. These reflect structural factors, different transmission dynamics, and operational issues. There is a need for improving the health service network with special emphasis on the less developed regions.

This Place Is Killing Me: A Comparison of Counties Where the Incidence Rates of AIDS Increased the Most and the Least

The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). Reported AIDS cases (1981-1990 and 1995-1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth-weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health.

AIDS in Women in the United States

The effect of the acquired immunodeficiency syndrome (AIDS) epidemic on women is substantial and warrants an updated analysis. To describe AIDS incidence trends in women. We analyzed national surveillance data on women 13 years of age and older with AIDS reported through June 1996. Data were adjusted for reporting delay, unreported risk, and the 1993 change in AIDS surveillance case definition to assess overall trends and examine trends by age group and birth cohort. Surveillance conducted by the Centers for Disease Control and Prevention in collaboration with state and local health departments. In 1995, women accounted for 19% of AIDS cases in adults; AIDS incidence rates per 100000 women were highest in black women (50.1), women in the Northeast (22.3), heterosexual contacts (5.5), and women living in metropolitan statistical areas with more than 1 million residents (15.9). Greatest increases in rates between 1991 and 1995 by region and mode of transmission were in the South and in heterosexual contacts. Greatest increases in AIDS incidence rates were observed in heterosexually infected women born between 1970 and 1974, ie, women who were 14 to 18 years old in 1988. These trends predict continued growth of the number of AIDS cases in women, especially in those in the South and those infected heterosexually, and suggest that successive cohorts of young women may be at risk for human immunodeficiency virus infection as they reach adolescence and young adulthood. Prevention programs must reach young women before they initiate sexual activity and drug use.

Tuberculosis, AIDS, and death among substance abusers on welfare in New York City.

In New York City, the incidence of tuberculosis has more than doubled during the past decade. We examined the incidence of tuberculosis and the acquired immunodeficiency syndrome (AIDS) and the rate of death from all causes in a very-high-risk group--indigent subjects who abuse drugs, alcohol, or both. In 1984 we began to study prospectively a cohort of welfare applicants and recipients 18 to 64 years of age who abused drugs or alcohol. The incidence rates of tuberculosis, AIDS, and death for this group were ascertained through vital records and New York City's tuberculosis and AIDS registries. The cohort was followed for eight years. Of the 858 subjects, tuberculosis developed in 47 (5.5 percent), 84 (9.8 percent) were given a diagnosis of AIDS, and 183 (21.3 percent) died. The rates of incidence per 100,000 person-years were 744 for tuberculosis, 1323 for AIDS, and 2842 for death. In this group of welfare clients, the rate of newly diagnosed tuberculosis was 14.8 times that of the age-matched general population of New York City; the rate of AIDS was 10.0 times as high; and the death rate was 5.2 times as high. There was no significant difference in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 1984. Among indigent alcohol and drug abusers in New York City, the rates of tuberculosis, AIDS, and death are extremely high. In this population, a single positive or negative skin test does not predict the development of tuberculosis, probably because both anergy and new infections are common. If programs to control tuberculosis and AIDS are to be effective in groups of indigent substance abusers, health services must be integrated into the welfare delivery system.

The expanding regional diversity of the acquired immunodeficiency syndrome epidemic in the United States

<h3>Background:</h3> The geographic spread of the human immunodeficiency virus (HIV) epidemic reflects multiple subepidemics in different regions and population groups. <h3>Methods:</h3> To describe regional trends in the acquired immunodeficiency syndrome (AIDS) in the United States, we analyzed national surveillance data for persons with AIDS diagnosed from 1988 through 1991. <h3>Results:</h3> Highest annual AIDS incidence rates were in the US territories (52.7 per 100000) and the Northeast (27.7 per 100 000). The greatest percentage increases were in the US territories (68.8%), the South (60.1%), and the Midwest (52.4%). Men who have sex with men constituted the majority of AIDS cases nationally (54.6%), as well as in the Midwest (67.8%), the South (57.4%), and the West (75.3%). Among injecting drug users, the greatest rates of increase in AIDS cases were observed among blacks in the South. Although large increases in the number of persons with HIV transmitted through heterosexual contact were reported from almost all regions, the largest increase was in the South. <h3>Conclusion:</h3> High rates of increase in AIDS cases from the Midwest, South, and US territories probably reflect later entry of HIV into these regions compared with the earlier HIV epidemics in large metropolitan areas of the Northeast and West. In particular, because the South has the largest population of the regions, and sexually transmitted disease surveillance data suggest that substantial populations in the South are at risk, the marked increase in AIDS incidence in this region suggests that the major impact of the epidemic may yet be seen. The continuing spread of HIV and AIDS in different communities and regions demonstrates the need to expand preventive and therapeutic services. (<i>Arch Intern Med</i>. 1994;154:654-659)

The Expanding Regional Diversity of the Acquired Immunodeficiency Syndrome Epidemic in the United States

The geographic spread of the human immunodeficiency virus (HIV) epidemic reflects multiple subepidemics in different regions and population groups. To describe regional trends in the acquired immunodeficiency syndrome (AIDS) in the United States, we analyzed national surveillance data for persons with AIDS diagnosed from 1988 through 1991. Highest annual AIDS incidence rates were in the US territories (52.7 per 100,000) and the Northeast (27.7 per 100,000). The greatest percentage increases were in the US territories (68.8%), the South (60.1%), and the Midwest (52.4%). Men who have sex with men constituted the majority of AIDS cases nationally (54.6%), as well as in the Midwest (67.8%), the South (57.4%), and the West (75.3%). Among injecting drug users, the greatest rates of increase in AIDS cases were observed among blacks in the South. Although large increases in the number of persons with HIV transmitted through heterosexual contact were reported from almost all regions, the largest increase was in the South. High rates of increase in AIDS cases from the Midwest, South, and US territories probably reflect later entry of HIV into these regions compared with the earlier HIV epidemics in large metropolitan areas of the Northeast and West. In particular, because the South has the largest population of the regions, and sexually transmitted disease surveillance data suggest that substantial populations in the South are at risk, the marked increase in AIDS incidence in this region suggests that the major impact of the epidemic may yet be seen. The continuing spread of HIV and AIDS in different communities and regions demonstrates the need to expand preventive and therapeutic services.

Lymphadenopathy syndrome in homosexual men. Evidence for continuing risk of developing the acquired immunodeficiency syndrome

Seventy-five homosexual men with lymphadenopathy syndrome (LAS) for three months or more and antibody against the human immunodeficiency virus were enrolled in a prospective study in Atlanta in 1982 and 1983. Fourteen developed the acquired immunodeficiency syndrome (AIDS) three to 38 months after enrollment in the study and five to 56 months after onset of LAS. The five-year cumulative incidence rate of AIDS after onset of LAS was 29%; yearly incidence rates showed no decreasing trend with time. Of 18 patients with constitutional symptoms and a low T-helper cell count at their first visit, nine developed AIDS; of the remaining 57 patients, five developed AIDS (five-year cumulative incidence rates, 57% and 18%, respectively, P less than .001). Patients with lymphadenopathy syndrome are at continuing risk for the development of AIDS. Those with constitutional symptoms and a low T-helper cell count at their first visit appear to be at higher risk; other LAS patients are at lower risk but may still develop AIDS.

Lymphadenopathy Syndrome in Homosexual Men

Seventy-five homosexual men with lymphadenopathy syndrome (LAS) for three months or more and antibody against the human immunodeficiency virus were enrolled in a prospective study in Atlanta in 1982 and 1983. Fourteen developed the acquired immunodeficiency syndrome (AIDS) three to 38 months after enrollment in the study and five to 56 months after onset of LAS. The five-year cumulative incidence rate of AIDS after onset of LAS was 29%; yearly incidence rates showed no decreasing trend with time. Of 18 patients with constitutional symptoms and a low T-helper cell count at their first visit, nine developed AIDS; of the remaining 57 patients, five developed AIDS (five-year cumulative incidence rates, 57% and 18%, respectively,<i>P</i>&lt;.001). Patients with lymphadenopathy syndrome are at continuing risk for the development of AIDS. Those with constitutional symptoms and a low T-helper cell count at their first visit appear to be at higher risk; other LAS patients are at lower risk but may still develop AIDS. (<i>JAMA</i>1987;257:335-337)

Incidence of the acquired immunodeficiency syndrome in San Francisco, 1980-1983.

Incidence data for the acquired immunodeficiency syndrome (AIDS) are presented on the basis of a surveillance file maintained by the San Francisco Bureau of Communicable Disease Control. The incidence of AIDS among residents of San Francisco rose steadily from the first case diagnosed in the last quarter of 1980 through the last quarter of 1983. New cases were diagnosed at a rate of 25 per month in the last quarter of 1983. Reported incidence declined in mid-1983, but the decline was probably a case-finding artifact. Smoothed incidence rates show a steady progressive rise, which is approximated equally well by quadratic or exponential curves. Among the patients diagnosed in San Francisco, 99% were homosexual or bisexual men. The cumulative incidence rate among homosexual or bisexual men was estimated to be 770 per 100,000 in the last quarter of 1983. The incidence rate of AIDS increased with age, and the increase was greater than that found with other sexually transmitted diseases. The difference in the age distributions between cases of AIDS and syphilis suggests either that susceptibility to AIDS increases with age or that the average latency associated with AIDS is longer than previously thought.

The Incidence Rate of Acquired Immunodeficiency Syndrome in Selected Populations

Population figures were obtained, and incidence rates of acquired immunodeficiency syndrome (AIDS) for the 12 months from June 1, 1983, to May 31, 1984, were estimated for single (never-married) men aged 15 years or older, intravenous (IV) drug users, Haitians living in the United States, persons with hemophilia A and B, female sexual contacts of male IV drug users, and blood transfusion recipients. Single men in San Francisco and Manhattan, IV drug users in New York City and New Jersey, hemophilia A patients, and recent Haitian entrants had the highest rates of disease (82.0 to 268.9 per 100,000). Male IV drug users and male Haitians were two to four times as likely to experience development of AIDS as were females in each group. Persons with hemophilia A had six times the incidence rate of AIDS as did those with hemophilia B. Persons with severe hemophilia A had three times the rate of those with moderate and seven times the rate of those with mild clotting factor deficiency. Although blood transfusion recipients and female sexual contacts of male IV drug users had much lower average yearly rates than did persons in the four other groups (0.4 to 9.4 per 100,000), they still had a higher incidence rate of AIDS than did persons not belonging to any of these groups (0.1 per 100,000).