Number Of New Human Immunodeficiency Virus Infections Research Articles

Ways of HIV transmission in China: The effect of age, period, and cohort.

BackgroundAcquired immunodeficiency syndrome (AIDS) is a global pandemic caused by human immunodeficiency virus (HIV), which is transmitted through human behaviors, such as sexual intercourse, intravenous drug injection, and blood transfusion. Rare studies have focused on the evaluation of the effects of culture, society, and HIV-related policies in adjusting people's HIV-related behaviors, i.e., ways of HIV transmission.MethodsBy taking the new HIV infections in Hubei Province each year from 1995 to 2020 as the sample, our study used the Hierarchical Age-Period-Cohort (HAPC) model to analyze the effects of age, period, and cohort on the trends of ways of HIV transmission.ResultsFrom 1995 to 2020, the number of new HIV infections in Hubei presented a general upward trend. A total of 34,636 HIV infections were reported during this period. According to the statistics of the new HIV infections in Hubei Province between 1995 and 2020, there is a negative correlation between age (−0.099, p < 0.001), squared age (−0.002, p < 0.001), and the rate of blood transmission. While there is a positive correlation between age (0.143, p < 0.001), squared age (0.002, p < 0.001), and the rate of HIV infection through sexual transmission. The significant period and cohort effects on ways of HIV transmission were also observed in the Chinese population.ConclusionSexual and blood transmission are the two main ways of HIV infection in China and Hubei. The trend of blood transmission is in accordance with the wave of blood trade in the early 1990s in China. The trend of sexual transmission indicates an increasing need to promote safer sexual behavior among the older population and later generations and design more tailored, innovative, and diverse HIV prevention strategies, especially for the high-risk groups.

Spatial pattern and determinants of sufficient knowledge of mother to child transmission of HIV and its prevention among Nigerian women.

The lack of sufficient knowledge of mother to child transmission (MTCT) of human immunodeficiency virus (HIV) among pregnant women is considered a major contributor to new pediatric HIV infections globally, and increasing HIV related infant mortality especially in developing countries. Nigeria has the highest number of new HIV infections among children in the world. This study was designed to examine the spatial pattern and determinants of acquisition of sufficient knowledge of MTCT and prevention of mother to child transmission (PMTCT) in Nigeria. The data used in the study were extracted from the 2018 Nigeria Democratic Health Survey. The spatial modeling was through a Bayesian approach with appropriate prior distributions assigned to the different parameters of the model and inference was through the integrated nested Laplace approximation technique (INLA). Results show considerable spatial variability in the acquisition of sufficient knowledge of MTCT and its prevention with women in the southwestern and southeastern part of the country having higher likelihood. The nonlinear effects findings show that acquisition of sufficient knowledge of MTCT and PMTCT increased with age of women and peaked at around age 35yearswhere it thereafter dropped drastically among the older women. Furthermore, sufficient knowledge of MTCT and PMTCT was found to be driven by ethnicity, respondents' education and wealth status.

Vital Signs: Status of Human Immunodeficiency Virus Testing, Viral Suppression, and HIV Preexposure Prophylaxis - United States, 2013-2018.

BackgroundApproximately 38,000 new human immunodeficiency virus (HIV) infections occur in the United States each year; these infections can be prevented. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates three strategies (diagnose, treat, and prevent HIV infection) and seeks to leverage testing, treatment, and preexposure prophylaxis (PrEP) to reduce new HIV infections in the United States by at least 90% by 2030. Targets to reach this goal include that at least 95% of persons with HIV receive a diagnosis, 95% of persons with diagnosed HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP. Using surveillance, pharmacy, and other data, CDC determined the current status of these three initiative strategies.MethodsCDC analyzed HIV surveillance data to estimate annual number of new HIV infections (2013–2017); estimate the percentage of infections that were diagnosed (2017); and determine the percentage of persons with diagnosed HIV infection with viral load suppression (2017). CDC analyzed surveillance, pharmacy, and other data to estimate PrEP coverage, reported as a percentage and calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons with indications for PrEP.ResultsThe number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500) (p = 0.448). In 2017, an estimated 85.8% of infections were diagnosed. Among 854,206 persons with diagnosed HIV infection in 42 jurisdictions with complete reporting of laboratory data, 62.7% had a suppressed viral load. Among an estimated 1.2 million persons with indications for use of PrEP, 18.1% had been prescribed PrEP in 2018.ConclusionAccelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.

The current state of human immunodeficiency virus-associated lymphoma in Japan: a nationwide retrospective study of the Japanese Society of Hematology Blood Disease Registry.

This retrospective nationwide study sought to clarify the current status of human immunodeficiency virus (HIV)-associated lymphoma in Japan, where the number of new HIV infections remains high. We extracted data of patients with HIV-associated lymphoma who were registered in the database of the Japanese Society of Hematology Blood Disease Registry from January 2012 to December 2015, and analyzed patient characteristics, pathological diagnosis, and outcomes. The study cohort included 79 patients, including 75 male patients, with a median age of 52.5 (25-88) years. Among the lymphoma subtypes reported, the most common was diffuse large B cell lymphoma (DLBCL), followed by Burkitt lymphoma and primary central nervous system lymphoma. Estimated 3-year overall survival (OS) of all types of HIV-associated lymphoma was 68.8% [95% CI 68.2-69.4%]. However, the rate of extranodal involvement at the time of diagnosis was 49.2% and half of DLBCL was international prognostic index high or high-intermediate, with poor prognosis. Patients with primary effusion lymphoma died within 6months. Even in an era of combination antiretroviral therapy, HIV-associated lymphoma remains an important problem. Clinical manifestations identified in this study were aggressive, and outcomes remained poor, warranting continuous surveillance of HIV-associated lymphoma.

Non-Occupational HIV Post-exposure Prophylaxis: A 10-Year Retrospective Review of Data Following Sexual Exposure From Yaounde Central Hospital, Cameroon.

Background:Human Immunodeficiency Virus (HIV) post exposure prophylaxis (PEP) consists of administering antiretroviral therapy within 72 hours of viral exposure and continued for four weeks. PEP has been shown to be an important means of preventing and decreasing the number of new HIV infections in the general population. The purpose of this study was to describe the profile of patients who consulted at the HIV/AIDS Care and Treatment Center of the Yaounde Central Hospital (YCH) for PEP following non-occupational exposure to HIV. To attain our objective, we carried out a 10-year retrospective review of patient records of all persons who consulted for accidental HIV exposure at the YCH, Cameroon.Methods:This study was an observational, retrospective analysis of hospital records of persons who consulted for PEP following accidental exposure to HIV in the outpatient HIV clinic at YCH between January 2007 and December 2016. Data extracted from patients’ records were: type of HIV exposure, sex, age, profession, level of education, HIV status of source and time to consultation. Descriptive and inferential statistics were analyzed using STATA IC 12.0. Results were presented as median and interquartile range for continuous variables. Categorical variables were expressed as frequencies and proportions.Results:There were 628 consultations for PEP of which 48% (299/628) were as a result of non-occupational post exposure prophylaxis (nPEP). Of those who consulted for HIV PEP following non-occupational exposure, 78% (234/299) were females; adolescents group (15-19 years) and young adults group (20 – 24yrs.) constituted 41% (125/299). Forty percent (1208/299) were secondary or high school students (level of education) and 88% (262/299) were non-healthcare workers. The median time-to-consultation for non-occupational PEP (nPEP) was 19 hours (IQR: 12.4-25.0) and HIV status of the source was unknown in 64% (191/299) of cases and positive for 8% (25/299) of cases. The most frequent indications for consulting were sexual assault, 75% (224/299); condom slippage or breakage, 10% (30/299); and unprotected consensual sexual intercourse, 15% (45/299).Conclusion and Global Health Implications:Consultations for nPEP are as frequent as those occupational PEP (48% vs 52% in this study) in clinical practice at YCH. A good history of the source is important as it prevents unnecessary prescriptions of ART (which themselves have potential side effects) for persons consulting for potential HIV non-occupational exposure. In our study, we found that 27% (82/299) unnecessary ART prescriptions were avoided by determining that the exposure source person had negative HIV status. In addition, adolescent or young females consulting for nPEP in clinics could be potential victims of sexual assault or gender-based violence. Where possible, we recommend that clinicians consider the source of suspected viral exposure in clinical practice prior to administering ART for PEP.

HIV/AIDS responses in China should focus on the impact of global integration.

China has made substantial progress in tackling its Human immunodeficiency virus (HIV) epidemic, however, the number of people living with HIV / acquired immunodeficiency syndrome (AIDS) continues to increase, with the number of all-cause deaths rising. There are a total 75.6 million people living with HIV and 2.39 million people newly infected with HIV as of December 31, 2017 in China. Besides, while the number of new HIV infections continued to decline in 2017 globally, the data from Chinese Center for Disease Control and Prevention (CCDC) show steady increases in new HIV infections in China. The compound annual growth rate (CAGR) of new HIV infections in China from 2012 to 2017 was 10.29%, and the CAGR of AIDS-related deaths was 5.92%. Moreover, there was a sudden increase in new HIV infections in China from January 2018, showing the compound monthly growth rate (CMGR) of 2018 increased by 9.92% compared to 2017. Given the advance of globalization, it is increasingly important to focus on the impact of global integration for HIV/AIDS responses, facing the increasing challenge of key affected populations such as men who have sex with men (MSM), young people and older people. Certainly, comprehensive strategies for prevention, drug treatment, and even functional cure will also be crucial for curbing the HIV epidemic in China in the new era.

Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition — United States, 2015

In 2014, approximately 40,000 persons in the United States received a diagnosis of human immunodeficiency virus (HIV) infection. Preexposure prophylaxis (PrEP) with daily oral antiretroviral medication is a new, highly effective intervention that could reduce the number of new HIV infections. CDC analyzed nationally representative data to estimate the percentages and numbers of persons in the United States, by transmission risk group, with indications for PrEP consistent with the 2014 U.S. Public Health Service's PrEP clinical practice guideline. Approximately 24.7% of sexually active adult men who have sex with men (MSM) (492,000 [95% confidence interval {CI} = 212,000-772,000]), 18.5% of persons who inject drugs (115,000 [CI = 45,000-185,000]), and 0.4% of heterosexually active adults (624,000 [CI = 404,000-846,000]), had substantial risks for acquiring HIV consistent with PrEP indications. Based on current guidelines, many MSM, persons who inject drugs, and heterosexually active adults have indications for PrEP. A higher percentage of MSM and persons who inject drugs have indications for PrEP than heterosexually active adults, consistent with distribution of new HIV diagnoses across these populations. Clinical organizations, health departments, and community-based organizations should raise awareness of PrEP among persons with substantial risk for acquiring HIV infection and their health care providers. These data can be used to inform scale-up and evaluation of PrEP coverage. Increasing delivery of PrEP and other highly effective HIV prevention services could lower the number of new HIV infections occurring in the United States each year.

The road to eliminate mother-to-child HIV transmission

The World Health Organization’s Global Health Observatory estimates that 78 million people have been infected with the human immunodeficiency virus (HIV) during the course of the epidemic, and that 39 million men, women, and children have died.1 Nearly 1 in 20 adults in sub-Saharan Africa are currently living with the infection. HIV represents one of the world’s most serious health problems. The WHO global health sector strategy on HIV/acquired immunodeficiency syndrome (AIDS) has identified four strategic directions to guide countries’ HIV response to achieve the United Nations’ Millennium Development Goal of halting the spread of HIV/AIDS. A core element of strategic direction one was the elimination of new HIV infections in children.2 It is encouraging that the number of new HIV infections in children is decreasing in most parts of the world. In 2011, there were approximately 330,000 new childhood infections, and while this is a reduction of 43% since 2003, it remains unacceptably high.3 Unfortunately, increased childhood infection rates were observed in Angola, Congo, Equatorial Guinea, and Guinea-Bissau. While a small proportion of childhood infections result from blood transfusions, sexual abuse, or unsafe injecting practices, the main cause is mother-to-child transmission

Human immunodeficiency virus and sexually transmitted diseases between the vulnerable populations in Kazakhstan

The human immunodeficiency virus (HIV) epidemic continues to expand in Eastern Europe and Central Asia according to UNAIDS data (2012, Geneva). The rate of new HIV infections AIDS – related mortality has increased by 25 % from 2001 to 2009 in Kazakhstan (WHO data, 2012). The number of new HIV infections among newly diagnosed patients attributed to heteroand homosexual contact has been steadily increasing. There is also higher rate of HIV among Injecting Drug Users. There is an increase incidence of co-infections especially sexually transmitted diseases. In fact, comorbid STIs increase patients' susceptibility of acquiring and transmitting HIV (Guenthner PC , Secor WE, Dezzutti CS., 2005; Kissinger P, Amedee A, Clark RA, et al. , 2009). HIV/AIDS shares transmission characteristics with other sexual and blood-borne agents. Higher sexual mixing rates and lack of condom use are conspicuous risk factors (Vermund et al. 2009). However, while all groups are affected by HIV, some are more vulnerable than others: sex workers (SWs), men who have sex with men (MSM), injecting drug users (IDU). All these findings determined to set up the goal of this research. The purpose of the study is еpidemiologic situation of human immunodeficiency virus (HIV/AIDS) and related STIs in the Republic of Kazakhstan and in some vulnerable population groups to HIV infection. Materials and methods. To study the dynamics of HIV/STIs in Kazakhstan (cumulatively) an analysis of 2012–2013 years statistics was conducted. Testing for HIV/STI of blood samples of the vulnerable groups was carried out in the laboratories of AIDS centers. The algorithm of confirming the diagnosis of HIV infection included a twofold enzyme immunoassay (EIA) study of blood samples. Samples with positive results of the first EIA were retested using expert test systems; in case with a positive result of the second EIA a confirmatory test was conducted using a method of HIV-1 Western blot in the reference laboratory of the Republican AIDS Center. Results. At the beginning of 2015 in Kazakhstan there were cumulatively recorded 24,216 cases of HIV infection, the rate of HIV prevalence in the population amounted to 128. By gender: HIV-infected total 22,109; among them 14,683 – men (66.4 %), 7,426 – women (33.6 %). By age: there was a predominance of people of a young, productive and reproductive age, of years from 15 to 39 (79.3 %). As far as the mode of HIV transmission is concerned a parenteral way is prevailing (intravenous drug use among IDUs) – 58.3 %, a heterosexual way – 36.3 % (women – 62 %, men – 38 %), a homosexual way – 0.9 %. Dynamics show increase of a sexual transmission of HIV (2014 – 59.8 %, a parenteral transmission – 31.7 %). The conducted analysis showed a median HIV prevalence among people who inject drugs (80.9 % and 85.2 %, years 2012–2013 respectively), sex workers (15 % and 12.3 %, years 2012–2013 respectively) and men who have sex with men (4 % and 2.5 %, years 2012–2013 respectively). Among SWs and homosexuals syphilis was diagnosed only in 13.2 % of all cases, more often among the sex workers (15 %) than among men who have sex with men (8.5 %).

Lifetime HIV Antiretroviral Therapy Adherence Intervention: Timing Is Everything

Modern, potent antiretroviral therapy regimens can suppress human immunodeficiency virus (HIV) replication indefinitely. For those who have access to these drugs and who are able to adhere on a daily basis to these drugs, life expectancy now approaches that of individuals without HIV infection, particularly if they start therapy early.1,2 Full lifetime viral suppression offers the potentially transformative public health benefit of reducing transmission leading to a decline in number of new HIV infections.3 For many patients, however, adequate adherence to sustain viral suppression over a lifetime remains a major challenge. Antiretroviral adherence declines over time.4-6 Even people with typically excellent adherence will experience treatment interruptions owing to inevitable disruptions in daily routine, relapse of substance use or mental illness, or simple pill fatigue. Interruptions of several days or more put patients at risk for virologic failure.7,8 As such, adherence support may be necessary for many, if not most, people at some time in the course of life-long treatment in order to achieve the full individual and public health impact of antiretroviral therapy. Providing adherence support over a lifetime of anti-retroviral therapy creates 2 major conundrums. First, most adherence interventions are time limited, and benefits do not typically last much beyond the cessation of the intervention.9 Second, we don't know when individuals most need adherence support during a lifetime of treatment. Continuous, lifelong adherence support is neither necessary nor possible. In this issue of the journal, Gross et al10 make significant progress toward a model of effective long-term adherence support. In a US population, they randomized subjects with plasma HIV-1 RNA levels higher than 1000 copies/mL who were initiating or changing therapy to an intervention of Managed Problem Solving (MAPS) vs usual care. Managed Problem Solving consisted of 4 in-person and 12 telephone-based meetings with a trained interventionist, followed by monthly follow-up calls for a year. In the primary intention-to-treat analyses, the odds ratio of being in a higher adherence category was 1.78 (95% CI, 1.07-2.96) times greater for MAPS than usual care, and the odds of having an undetectable HIV RNA level were 1.48 (95% CI, 0.94-2.31) times greater for MAPS than usual care. The effect was sustained for 12 months, involved minimal interaction with the study participants, and did not deteriorate over time. While this intervention achieved a durable behavioral and biologic effect, calling every HIV-infected person on treatment every month of their life may not be feasible or necessary. We believe that to maximize the benefit of the findings reported herein, individuals who might benefit from MAPS need to be offered this intervention in connection with adherence lapses. One such approach is to use life-long, real-time adherence monitoring. Real-time adherence monitoring involves electronic pill containers that transmit a time and date stamp with an anonymous patient identifier to a central server through mobile networks every time the pill container is opened. Monitoring detects missed doses in real time and thus provides a means to link MAPS (or other interventions) to an individual before treatment failure occurs. Support can be provided not on a fixed monthly interval, as in the study by Gross et al,10 but rather only when needed in the midst of an adherence lapse. “Just-in-time” adherence support can be delivered by text message, live counseling over the telephone, or in person, depending on the duration and cause of the adherence lapse. While the cost of electronic monitors is not insignificant, on a large scale, real-time monitoring and adherence-driven support could be provided at costs comparable with those of current laboratory monitoring for HIV. This approach transforms HIV care from largely responding, to proactively preventing virologic failure in real time. It is potentially cost-effective when considering the savings achieved through long-term virologic suppression, which prevents need for resistance testing, avoids the use of more expensive second-line regimens, and avoids devoting substantial resources to managing the complications of disease progression. Initial studies have shown real-time adherence monitoring to be feasible even in areas with limited infrastructure.11 Moving forward, research is needed to establish effectiveness and ultimately scalability outside the research context. The introduction of combination antiretroviral therapy transformed HIV from a terminal to a chronic disease in the late 1990s. Advances in simpler, more potent therapy transformed treatment from success in some to success in most in the 2000s. Advances in just-in-time adherence monitoring and support delivered when and where it is needed may transform treatment from success measured over years to success measured over a lifetime.

Understanding the modes of tranmission model of new HIV infection and its use in prevention planning

The modes of transmission model has been widely used to help decision-makers target measures for preventing human immunodeficiency virus (HIV) infection. The model estimates the number of new HIV infections that will be acquired over the ensuing year by individuals in identified risk groups in a given population using data on the size of the groups, the aggregate risk behaviour in each group, the current prevalence of HIV infection among the sexual or injecting drug partners of individuals in each group, and the probability of HIV transmission associated with different risk behaviours. The strength of the model is its simplicity, which enables data from a variety of sources to be synthesized, resulting in better characterization of HIV epidemics in some settings. However, concerns have been raised about the assumptions underlying the model structure, about limitations in the data available for deriving input parameters and about interpretation and communication of the model results. The aim of this review was to improve the use of the model by reassessing its paradigm, structure and data requirements. We identified key questions to be asked when conducting an analysis and when interpreting the model results and make recommendations for strengthening the model's application in the future.

Treatment of opioid dependence: a call for papers

Treatment of opioid dependence: a call for papers

Reply to Marks et al

TO THE EDITOR—The letter from Marks and colleagues contributes to the accumulating data on the spectrum of engagement in human immunodeficiency virus (HIV) infection care and its implications for test-and-treat strategies for HIV prevention [1]. In our study, we estimate that 19% of HIV-infected individuals in the United States have an HIV-1 RNA level (viral load) of <50 copies/mL [2]. By utilizing meta-analytic data and previously unpublished data from multiple US HIV care centers, Marks and colleagues estimate that 29% of HIV-infected individuals in the United States have a viral load of <75 copies/mL and that 34% have a viral load of <400 copies/mL [1]. On the basis of their estimate or ours, the majority of HIV-infected individuals in the United States has detectable HIV-1 RNA levels and thus can contribute to the forward transmission of HIV infection. The estimates of the proportion of US HIV-infected individuals with undetectable HIV-1 RNA levels by Marks and colleagues [1] fall within the range of our simulations (Figure 3 in our article [2]). Our simulations were admittedly simplistic because most varied the estimate of successful transition across a single step in the engagement cascade. We used this approach because these were the best available estimates in the published literature and to demonstrate the effect of uncertainty in our estimates of successful transition at each stage of the engagement in care spectrum. Although Marks and colleagues add important information to the available data on the spectrum of HIV care, we believe their analyses have limitations that may cause an overestimation of the proportion of US HIV-infected individuals with an undetectable HIV-1 load. The major limitation is that rates of initial linkage to HIV care were not clearly taken into account. Marks and colleagues use an estimate of 59% for retention in HIV care over time [3]. In the meta-analysis on which this number is based, it was also found that just 69% of individuals with diagnoses of HIV infection in the United States entered HIV medical care over time [3]. It is very challenging for individual care centers to estimate the number of individuals who fail initial linkage because the total number of new HIV infections is difficult to ascertain. In that regard, studies utilizing state databases frequently can account for linkage failure and retention failure at the same time. For this reason, these studies were preferentially used in our review [2]. In the meta-analysis used by Marks and colleagues [1], studies that utilized state databases estimated that 45% of individuals were retained in HIV care [3]. We have other smaller concerns regarding the analyses by Marks and colleagues. In the quoted meta-analysis, more recent engagement in care studies performed since 2003 demonstrated that only 42% of individuals were adequately retained in care [3]. Furthermore, included in the 59% estimate are studies that utilized patient self-report of engagement in HIV care. In these studies, 72% of individuals were engaged in care, which may be an overestimate [3]. Thus, more recent and more objective measures of engagement in care suggest that the 59% figure overestimates retention in care. Finally, we have some concern that the cohort data presented in the letter of Marks and colleagues may have excluded patients who may be less likely to use and adhere to antiretroviral therapy by requiring a clinic visit coupled with a viral load measurement within 90 days of that visit. Although we list these potential limitations of the data presented by Marks and colleagues, we feel that their work adds important information on rates of virologic suppression in real-world clinic settings in the United States. We would argue that their results are not substantially different from ours. On the basis of their estimate or ours, 66%–81% of HIV-infected individuals in the United States have detectable HIV-1 RNA levels, which is inadequate to achieve the goals of the National HIV/AIDS Strategy and to prevent HIV transmission at the population level. Strategies to improve all aspects of the engagement in care spectrum are needed to decrease the ‘national viral load, which has the potential to incrementally decrease HIV infection incidence in the United States in years to come.

Human Immunodeficiency Virus-Associated Tuberculosis

Human Immunodeficiency Virus-Associated Tuberculosis

Criminal Prosecution and Human Immunodeficiency Virus–Related Risky Behavior

We examine the consequences of prosecuting people who are human immunodeficiency virus (HIV) positive and expose others to the infection. We show that the effect of such prosecutions on the spread of HIV is a priori ambiguous. The prosecutions deter unsafe sex. However, they also create incentives for having sex with partners who are more promiscuous, which consequently increases the spread of HIV. We test these predictions and find that such prosecutions are associated with a reduction in the number of partners, an increase in safe sex, and an increase in sex with prostitutes. We estimate that doubling the prosecution rate could decrease the total number of new HIV infections by one-third over a 10-year period.

Trends in HIV/AIDS Diagnoses—33 States, 2001-2004

In 2003, more than 1 million persons in the United States were estimated to be living with human immunodeficiency virus (HIV) infection. As a result of advances in treatment with highly active antiretroviral therapy (HAART) since 1996, persons infected with HIV are living longer than before and progression to acquired immunodeficiency syndrome (AIDS) has decreased. Consequently, AIDS surveillance no longer provides accurate population-based monitoring of the current HIV epidemic. Therefore, CDC recommends that all states and territories adopt confidential, name-based surveillance systems to report HIV infection. This report describes the characteristics of persons for whom HIV infection was diagnosed during 2001-2004 and reported to 33 state and local health departments with name-based HIV reporting. The findings indicate that the rate of HIV diagnosis in these states decreased among non-Hispanic blacks from 2001 to 2004; however, the rate of HIV diagnosis among blacks remained disproportionately high. In 2004, the rate among blacks was 8.4 times higher than among whites. Improved knowledge of HIV status and access to care and prevention services is important to decrease the number of new HIV infections among those populations most affected.

HIV Incidence Among Injection Drug Users Enrolled in a Los Angeles Methadone Program

To the Editor. —To estimate the human immunodeficiency virus (HIV) seroconversion rate among injection drug users (IDUs) entering a methadone treatment (maintenance or 21-day detoxification) program in Los Angeles, Calif, we retrospectively reviewed the records of all clients confidentially tested for HIV at one drug treatment center in Los Angeles between March 1989 and January 1994. All IDUs who had a negative HIV test when they first entered drug treatment, who had at least two HIV tests in the first or any subsequent treatment episode during the study period, and who had a history of injection drug use in the 12 months before they entered treatment were included in the analysis. The date of seroconversion was assigned as the midpoint between the last negative and first positive test. Seroconversion rate was calculated as the number of new HIV infections per 1000 person-years of observation. During the 56-month study period, 3931

Surveillance of Human Immunodeficiency Virus (HIV) Antibodies in Medicolegal Autopsies in Finland—Monitoring Early Changes in HIV-Seropositivity Among Risk Groups and Average Population

In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku--two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.