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U.S. understated HIV infection rate

Aug. 2, 2008
Asso­ciated Press

The num­ber of Amr­i­cans in­fected by the AIDS vi­rus each year is much high­er than the gov­ern­ment has been es­ti­mat­ing, U.S. health of­fi­cials re­ported, ac­knowl­edg­ing that their num­bers have un­der­stated the lev­el of the ep­i­dem­ic. 

The con­try had roughly 56,300 new HIV in­fec­tions in 2006 — about a 40 per­cent in­crease from the 40,000 an­nu­al es­ti­mate used for the past doz­en years. The new fig­ure is due to a bet­ter blood test and new sta­tis­ti­cal meth­ods, and not a wors­en­ing of the ep­i­dem­ic, of­fi­cials said.

But it likely will re­fo­cus U.S. at­tn­tion from the ef­fect of AIDS over­seas to what the dis­ease is do­ing to this coun­try, said pub­lic health re­search­ers and of­fi­cials. “This is the big­gest nws for pub­lic health and HIV/AIDS that we’ve had in a while,” said Ju­lie Sco­field, ex­ec­u­tive di­rec­tor of the Na­tional Al­li­ance of State and Ter­ri­to­rial AIDS Di­rec­tors.

Ex­perts in the field, ad­v­cates and a form­er sur­geon gen­er­al called for more ag­gres­sive test­ing and oth­er pre­ven­tion ef­forts, not­ing that spend­ing on pre­vent­ing HIV has been flat for sev­en years. The re­vised es­ti­ate by the Cen­ters for Dis­ease Con­trol and Pre­ven­tion and the meth­od­ol­o­gy be­hind it were to be pre­sented Sun­day, the open­ing day of the in­terna­t­ional AIDS con­fer­ence in Mex­i­co City.

Since AIDS sur­faced in 1981, halth of­fi­cials have strug­gled to es­ti­mate how many peo­ple are in­fected each year. It can take a dec­ade or more for an in­fec­tion to cause symp­toms and ill­ness.

One ex­pert likened the new es­ti­mate to adding a god speed­om­e­ter to a car. Sci­en­tists had a good gen­er­al idea of where the ep­i­dem­ic was go­ing; this pro­vides a bet­ter un­der­stand­ing of how fast it’s mov­ing right now. “This puts a key part of the dash­bord in place,” said the ex­pert, Da­vid Holt­grave of Johns Hop­kins Uni­ver­s­ity.

Judg­ing by the new cal­cula­t­ons, of­fi­cials be­lieve an­nu­al HIV in­fec­tions have been hov­er­ing around 55,000 for sev­er­al years. “This is the most re­li­a­ble es­i­mate we’ve had since the be­gin­ning of the ep­i­dem­ic,” said Ju­lie Ger­berd­ing, the CD­C’s di­rec­tor. She said oth­er coun­tries may adopt the agen­cy’s meth­od­ol­o­gy.

Ac­cord­ing to cur­rnt es­ti­mates, around 1.1 mil­lion Amer­i­cans are liv­ing with the AIDS vi­rus. Of­fi­cials plan to up­date that num­ber with the new cal­cula­t­ions but don’t think it will change dra­mat­ic­ally, a CDC spokes­wom­an said.

The new in­fec­tion es­ti­mate is ased on a blood test that for the first time can tell how re­cently an HIV in­fec­tion oc­curred. Past tests could de­tect nly the pres­ence of HIV, so de­ter­min­ing which year an in­fec­tion took place was guess­work — guess­work up­on which the old 40,000 es­ti­mate was based.

The new es­ti­mate re­lies on blood tests from 22 states were health of­fi­cials have been us­ing a new HIV test­ing meth­od that can dis­tin­guish in­fec­tions that oc­curred with­in the past five months from those that were old­er. The im­proved sci­ence will al­low more ral-time mon­i­tor­ing of HIV in­fec­tions. Now, CDC of­fi­cials say, the es­ti­mate will likely be up­dated eve­ry year.

Yearly es­ti­mates al­low bet­ter rec­g­ni­tion of trends in the U.S. ep­i­dem­ic. For ex­am­ple, the new re­port found that in­fec­tions are fall­ing among het­ero­sex­u­als and in­jec­tion drug users.

Some ex­perts cel­e­brat­ed that fid­ing, say­ing it’s a trib­ute to pre­ven­tion ef­forts, in­clud­ing nearly 200 sy­ringe ex­change pro­grams now op­er­at­ing in 36 states de­spite a fed­er­al ban on fund­ing for such pro­jects. But they al­so la­ment­ed the CD­C’s find­ing that in­fec­tions co­tin­ue to in­crease in gay and bi­sex­u­al men, who ac­counted for more than half of HIV in­fec­tions in 2006. Al­so, more than a third of those with HIV are young­er than 30. 

Some ad­vo­cates say that sug­gests a need for more pre­en­tion ef­forts, par­tic­u­larly tar­get­ing young­er gay and bi­sex­u­al men. 

For years, AIDS was con­sid­ered a ter­ri­ fy­ing death sen­tence, and since 1981, more than half a mil­lion Amer­i­cans have died. But medicines that be­came avail­a­ble in the 1990s turned it in­to a man­age­a­ble chron­ic con­di­tion for many Amer­i­cans, and at­ten­tion shifted to Af­ri­ca and oth­er parts of the world. 

Last week, Pres­ident Bush siged a $48 bil­lion glob­al AIDS bill to con­tin­ue a pro­gram that he called “the larg­est com­mit­ment by any na­tion to com­bat a sin­gle dis­ease in hu­man his­to­ry.” 

But some ad­vo­cates com­plain that CD­C’s an­nu­al send­ing on HIV pre­ven­tion in the Un­ited States has been held to roughly $700 mil­lion since 2001, while costs have ris­en. (That’s about 3 per­cent of what the fed­er­al gov­ern­ment spends on AIDS; much of the rest is on medicines, health care and re­search.) 

The new es­ti­mate is “ev­i­ence of a fail­ure by gov­ern­ment and so­ci­e­ty to do what it takes to con­trol the ep­i­dem­ic,” said Ju­lie Da­vids, ex­ec­u­tive di­rec­tor of the Com­mun­ity HIV/AIDS Mo­bil­iz­a­tion Proj­ect. 

Wheth­er more fund­ing coes or not, the re­vised es­ti­mate clearly is a “wake-up call to scale things up,” said Kev­in Fen­ton, who over­sees CD­C’s pre­ven­tion ef­forts for HIV/AIDS. 

Some said more at­en­tion needs to fo­cus on pre­ven­tion among blacks, who ac­count for nearly half of an­nu­al HIV in­fec­tions, ac­cord­ing to the new CDC re­port. A re­cent re­port by the Black AIDS In­si­tute con­clud­ed that if black Amer­i­cans were their own na­tion, they would rank 16th in the world in the num­ber of peo­ple liv­ing with HIV. 

“We have been in­ad­e­qutely fund­ing this ep­i­dem­ic all along. We need to step it up,” said form­er U.S. Sur­geon Gen­er­al Da­vid Satcher, who is now an ad­min­is­tra­tor at At­lanta’s More­house School of Med­i­cine. 

The new es­ti­mate has been an­ti­cipated for a long time. The CDC b­gan work­ing on the new meth­ods nearly sev­en years ago. Late last year, ad­vo­cates said they had hard the fig­ure was about 55,000 and pressed the CDC to re­lease it. Agen­cy of­fi­cials de­clined, say­ing they were sub­mit­ting their re­search for med­i­cal jour­nal re­view. 

“These are ex­tremely com­pli­cat­ed sta­ti­ti­cal meth­ods,” and CDC of­fi­cials wanted the work to be thor­oughly re­viewed by out­side ex­perts, Ger­berd­ing said. The CD­C’s find­ings are be­ing pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­socia­t­ion. 

Un­til 1992, the num­ber of di­g­nosed AIDS cases was used to pre­dict how many peo­ple were newly in­fected each year. That meth­od pro­duced an es­ti­mate of 40,000 to 80,000. More re­cently, the CDC fo­cused on in­fec­tions among men who have sex with men, who ac­count for about half of new HIV di­ag­noses.


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Homepage image: HIV-infected human T-cells (Courtesy NIH)

 

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The number of Americans infected by the AIDS virus each year is much higher than the government has been estimating, U.S. health officials reported, acknowledging that their numbers have understated the level of the epidemic.