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CDC Reports Higher Rates of New HIV Cases, Causes Controversy
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New Technology Reveals Higher Number of New HIV Infections in the United States than Previously Known
"Too many Americans continue to be affected by this disease," stressed the CDCs Kevin Fenton. "These new findings emphasize the importance of reaching all HIV-infected individuals and those at risk with effective prevention programs."....."We must all remember that we are dealing with one of the most insidious infectious diseases in history"
The Centers for Disease Control and Prevention (CDC) announced today that an estimated 56,300 HIV infections occurred in the United States in 2006. That estimate differs from the agency_s previous estimate of 40,000 because CDC is now using a more precise method for estimating annual HIV incidence, which is the number of individuals who become newly infected with HIV in a given year. The new estimate is published today in a special HIV/AIDS issue of the Journal of the American Medical Association, released at the XVII International AIDS Conference in Mexico City.
"These data, which are based on new laboratory technology developed by CDC, provide the clearest picture to date of the U.S. HIV epidemic, and unfortunately we are far from winning the battle against this preventable disease," said CDC Director Dr. Julie Gerberding. "We as a nation have to come together to focus our efforts on expanding the prevention programs we know are effective."
The new estimate is derived from the first national surveillance system of its kind that is based on direct measurement of new HIV infections and builds on a new laboratory test (the BED HIV-1 Capture Enzyme Immunoassay) that can distinguish recent from long-standing HIV infections. CDC's prior annual HIV incidence estimate was based on indirect and less precise methods available at the time.
A separate CDC historical trend analysis published as part of today_s study suggests that the number of new infections was likely never as low as the previous estimate of 40,000 and has been roughly stable overall since the late 1990s.
"It's important to note that the new estimate does not represent an actual increase in the number of new infections, but reflects our ability to more precisely measure HIV incidence and secure a better understanding of the epidemic," said Kevin Fenton, M.D., director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "This new picture reveals that the HIV epidemic is - and has been - worse than previously known and underscores the challenges in confronting this disease."
Burden Greatest Among Gay and Bisexual Men of All Races and African Americans
CDC's new surveillance system also provides more precise estimates than previously possible of new infections in specific populations. Results confirm that the impact of HIV remains greatest among gay and bisexual men of all races and among African American men and women. In 2006, men who have sex with men (MSM) accounted for 53 percent of those with new infections (28,700), heterosexuals for 31 percent (16,800), and injection drug users (IDU) for 12 percent (6,600). Infection rates among blacks were 7 times as high as whites (83.7/100,000 people versus 11.5/100,000) and almost 3 times as high as Hispanics (29.3/100,000 people), a group that was also disproportionately affected.
"Too many Americans continue to be affected by this disease," stressed Fenton. "These new findings emphasize the importance of reaching all HIV-infected individuals and those at risk with effective prevention programs.".....
Separate Trend Analysis Sheds New Light on History of U.S. Epidemic
In addition to the 2006 HIV incidence estimates, CDC conducted a separate, historical analysis that provides new insight into HIV incidence trends over time - overall and for specific populations. Results confirm dramatic declines in the number of new HIV infections from a peak of about 130,000 in the mid-1980s to a low of roughly 50,000 annual infections in the early 1990s. However, findings also indicate that new infections increased in the late 1990s, but have remained roughly stable since that time (with estimates ranging between 55,000 and 58,500 during the three most recent time periods analyzed).
"Prevention can and does work when we apply what we know," said Richard Wolitski, Ph.D., acting director of CDC's Division of HIV/AIDS Prevention. "While the level of HIV incidence is alarming, stability in recent years suggests that prevention efforts are having an impact. In this decade, more people are living with HIV and living longer than ever before due to advances in treatment. Even though this could mean more opportunities for transmission, the number of new infections has not increased overall. "
The analysis revealed some other encouraging signs of progress as well as significant challenges among specific groups. Findings indicated reductions in new infections among both injecting drug users and heterosexuals over time. Yet, the findings also indicate that HIV incidence has been steadily increasing among gay and bisexual men since the early 1990s, confirming a trend suggested by other data showing increases in risk behavior, sexually transmitted diseases and HIV diagnoses in this population throughout the past decade. The analysis also found that new infections among blacks are at a higher level than any other racial or ethnic group, though they have been roughly stable, with some fluctuation, since the early 1990s.
"These data confirm the critical need to revitalize prevention efforts for gay and bisexual men of all races and to build upon the growing momentum in the African American and Hispanic communities to confront HIV," said Wolitski. "We must all remember that we are dealing with one of the most insidious infectious diseases in history. Reducing this threat will require action from everyone - individuals at risk, community leaders, government agencies and the private sector."
AIDS Prevention Having an Effect
New Cases Have Stabilized Since 1998, CDC Reports in Update on Epidemic
By David Brown
Washington Post Staff Writer
Sunday, August 3, 2008
Updated federal estimates of the annual number of new HIV infections in the United States, released yesterday, reveal that although the AIDS epidemic here is worse than previously thought, prevention efforts appear to be having some effect.
Even though the number of Americans living with HIV has risen by more than a quarter-million people since 1998 -- largely because of life-extending antiretroviral drugs -- the number of new cases each year has declined slightly over that period. That suggests that a person's likelihood of transmitting the virus to someone else is substantially lower now than it was a decade ago.
The new, if indirect, evidence that prevention programs are paying off was one of the few encouraging findings in an update on the American AIDS epidemic released yesterday by the Centers for Disease Control and Prevention on the eve of the 17th International AIDS Conference, in Mexico City.
"Over 95 percent of people living with HIV are not transmitting to someone else in a given year," said David R. Holtgrave, an expert on AIDS prevention at the Bloomberg School of Public Health at Johns Hopkins University. "What that says is the transmission rate has been kept very low by prevention efforts."
Those include targeting public health messages to high-risk groups, promoting widespread AIDS testing, and getting quick medical care for newly diagnosed cases, which in most cases lowers the person's infectiousness.
The CDC spends about $750 million a year on AIDS prevention. The main finding of its report is that HIV incidence in 2006 -- the latest year for which data are available -- was 56,300 new cases of infection. That is 40 percent higher than the previous government estimate of 40,000, but statistical back calculation suggests that HIV incidence has been unchanged since about 2000.
The more accurate estimate was possible for two reasons. A new testing method lets researchers detect infections that are less than six months old -- which is more quickly than before. New federal regulations also are pushing states to collect data on new HIV infections and not just new AIDS diagnoses.
By the time AIDS is diagnosed, the infection has severely damaged the immune system, making the person vulnerable to unusual infections and cancers. This generally occurs eight to 11 years after infection, assuming that there is no treatment with antiretroviral drugs, which can prolong life for many more years.
In December, The Washington Post reported that the CDC was revising HIV incidence upward to 50,000 to 60,000 cases a year. Yesterday's announcement -- and the publication of a paper in the Journal of the American Medical Association -- is the first official acknowledgment of the new, higher estimate.
"These data corroborate what many of us suspected -- that the epidemic is worse than we thought. However, it doesn't seem to be getting worse," said Jennifer Kates, director of HIV policy at the Kaiser Family Foundation in Washington.
The CDC's portrait of the American AIDS epidemic today shows that gay and bisexual men -- especially those who are young or black -- and their female partners are at particular risk.
In 2006, 73 percent of new HIV infections were in men, 53 percent were acquired through homosexual intercourse, and 45 percent were in African Americans. The incidence rate -- the number of infections per 100,000 people -- was seven times higher in blacks and three times higher in Hispanics than in whites. It was highest in people in their 30s, although people younger than 30 accounted for nearly 34 percent of new infections.
The new study also sketches a 30-year picture of how the epidemic has evolved.
Annual incidence peaked in 1985 at 130,000 infections, dipped to 49,000 in the early 1990s, rose to 58,000 in 1998 and has stabilized at about 56,000 a year.
The number of new of HIV cases acquired through drug injection fell by 80 percent over that period through reduced needle sharing by drug users and, in some places, needle-exchange programs. Infections acquired through homosexual sex, which also peaked in the early 1980s, fell to a low in the early 1990s but have risen steadily since then.
The epidemic in the black community is distinctly different from the national epidemic.
From 2001 to 2005, 38 percent of the new diagnoses in African Americans were in women, and 46 percent of new infections overall were from heterosexual contact. Among whites during the same period, 16 percent of new infections were in women, and 16 percent were from heterosexual transmission.
About half of the CDC's HIV prevention budget targets the black community, said Kevin Fenton, who heads those activities at the agency. He said, however, that the rising HIV incidence in gay men, and in young black gay men especially, is evidence that prevention campaigns have "not reached all those who need it."
Statistics compiled by the Kaiser Family Foundation show that 4 percent of the $23 billion the U.S. government is spending this year on all HIV-AIDS activities (including research, medical care and overseas programs) goes toward prevention.
According to a paper published last year in the American Journal of Preventive Medicine, in inflation-adjusted dollars, the CDC's budget for AIDS prevention in 2006 was only 5 percent higher than it was in 1990.
H.I.V. Study Finds Rate 40% Higher Than Estimated
NY Times
By LAWRENCE K. ALTMAN
Published: August 3, 2008
from Jules: like I've been saying for a long time more money is needed for domestic HIV; key concerns include HIV among Blacks and Latinos, aging with HIV and certain complications like bone disease, neurological complications, and diabetes.
"...Infection rates among blacks were found to be seven times as high as for whites (83.7 per 100,000 people versus 11.5 per 100,000) and almost three times as high as for Hispanics (29.3 per 100,000 people), a group that was also disproportionately affected......"H.I.V. prevention has been underfunded and too often hindered by politics and ideology," Mr. Waxman said in a statement released Saturday.....He said the administration had reduced domestic spending against H.I.V. "Since fiscal year 2002, when adjusted for inflation, C.D.C.'s prevention budget has actually shrunk by 19 percent. The president has recently requested decreases in funding for H.I.V. prevention at C.D.C.".....Mr. Waxman said he would soon hold hearings on why health officials had had "less and less money to actually get these programs to the communities that need them."....Dr. Alcabes disagreed with critics who contend that the new numbers point to a failure of United States policy on AIDS, saying his conclusion was that "it looks like prevention campaigns make even less difference than anyone thought."...."H.I.V. incidence did not decline as much from the 1980s to the 1990s as we believed," he said, "despite the dramatic increase in condom promotion and so-called prevention education."..."
MEXICO CITY Ñ The United States has significantly underreported the number of new H.I.V. infections occurring nationally each year, with a study released here on Saturday showing that the annual infection rate is 40 percent higher than previously estimated.
The study, conducted by the Centers for Disease Control and Prevention, found that 56,300 people became newly infected with H.I.V in 2006, compared with the 40,000 figure the agency has cited as the recent annual incidence of the disease.
The findings confirm that H.I.V., the virus that causes AIDS, has its greatest effect among gay and bisexual men of all races (53 percent of all new infections) and among African-American men and women.
The new figures are likely to strongly influence a number of decisions about efforts to control the epidemic, said the disease centers' director, Dr. Julie L. Gerberding, and other AIDS experts. Timely data about trends in H.I.V. transmission, they said, is essential for planning and evaluating prevention efforts and the money spent on them.
Dr. Gerberding said the new findings were "unacceptable," adding that new efforts must be made to lower the infection rates. "We are not effectively reaching men who have sex with men and African-Americans to lower their risk," she said.
Dr. Kevin A. Fenton, who directs H.I.V. prevention efforts at the agency, said, "C.D.C.'s new incidence estimates reveal that the H.I.V. epidemic is and has been worse than previously known."
A separate historical trend analysis published as part of the study suggests that the number of new infections was probably never as low as the earlier estimate of 40,000 and that it has been roughly stable overall since the late 1990s.
C.D.C. officials said the revised figure did not necessarily represent an increase in the number of new infections but reflected the ability of a new testing method to more precisely measure H.I.V. incidence and secure a better understanding of the epidemic.
Dr. Philip Alcabes, an epidemiologist at Hunter College in Manhattan, raised questions about the validity of the findings. If they are true, Dr. Alcabes said in a statement, the agency has undercounted new H.I.V. infections by about 15,000 per year for about 15 years. "Therefore, there are roughly 225,000 more people living with H.I.V. in the U.S. than previously suspected," he said. "The previous estimate was 1 million to 1.1 million."
A C.D.C. spokeswoman said Dr. Alcabes's estimates were incorrect because the new figures could not be used to calculate the total number of people with H.I.V. The C.D.C. does not know the total number but is expected to determine it later in the year.
The C.D.C., the federal agency responsible for tracking the AIDS epidemic in the United States, said its new monitoring system provided more precise estimates than were previously possible of new infections in specific populations. Infection rates among blacks were found to be seven times as high as for whites (83.7 per 100,000 people versus 11.5 per 100,000) and almost three times as high as for Hispanics (29.3 per 100,000 people), a group that was also disproportionately affected.
The C.D.C. has known of the new figures since last October, when the authors completed a manuscript and sent it to the first of three journals. But the agency refused to release the findings until they were published in a peer-reviewed medical journal. The first two journals rejected the authors' request for a fast-track review.
The paper is being published in the Aug. 6 issue of The Journal of the American Medical Association. The journal and the disease centers had planned to release it at a news conference on Sunday at the opening of the 17th International AIDS Conference here. But the paper was released on Saturday because the embargo was broken. A number of leading health experts have criticized the agency for not releasing the information earlier. On Nov. 21, C.D.C. officials told AIDS advocacy groups and reporters that the data would be released soon.
In an editorial on June 21, The Lancet, an internationally prestigious journal published in London, severely criticized the disease centers for failing to release the information and said, "U.S. efforts to prevent H.I.V. have failed dismally."
Dr. Gerberding, in defending the decision not to release the data earlier, said: "This paper has been scrutinized by some of the best statisticians in the country and is much better now than when we started this process. It was so complicated that even I, who has some expertise in this area, could not stand by it without making sure we had gone through the review process."
She added, "This is one of those examples where getting the external review process to really scrutinize the paper, pick it apart, build it back up, has in my opinion fundamentally improved it."
The delay, however, has also fueled criticism that the Bush administration, which has earned plaudits for spending tens of billions to fight AIDS in a number of highly affected countries, has not done enough to fight the disease at home.
Representative Henry A. Waxman, Democrat of California and chairman of the Committee on Oversight and Government Reform, was critical of the administration. "H.I.V. prevention has been underfunded and too often hindered by politics and ideology," Mr. Waxman said in a statement released Saturday.
He said the administration had reduced domestic spending against H.I.V. "Since fiscal year 2002, when adjusted for inflation, C.D.C.'s prevention budget has actually shrunk by 19 percent. The president has recently requested decreases in funding for H.I.V. prevention at C.D.C."
Mr. Waxman said he would soon hold hearings on why health officials had had "less and less money to actually get these programs to the communities that need them."
Dr. Alcabes disagreed with critics who contend that the new numbers point to a failure of United States policy on AIDS, saying his conclusion was that "it looks like prevention campaigns make even less difference than anyone thought."
"H.I.V. incidence did not decline as much from the 1980s to the 1990s as we believed," he said, "despite the dramatic increase in condom promotion and so-called prevention education."
The C.D.C. said the findings confirmed sharp declines in the number of new H.I.V. infections each year, from a peak of about 130,000 in the mid-1980s to a low of roughly 50,000 in the early 1990s. But the findings also indicate that the number of new infections increased in the late 1990s but has since remained relatively stable, with estimates of 55,000 to 58,500 in the three most recent time periods analyzed.
Dr. Gerberding said: "If there is any good news here, it is hard to report it, but there is a little bit in the sense that while incidence rates are certainly too high, they are stable. That is important because a stable number of new infections in a world that has got more and more people with H.I.V. and people with AIDS living in it suggests that we are keeping up with that pressure for transmission."
The revised figures are based on a new laboratory test that can distinguish between recent and long-standing H.I.V. infection, as well as on statistical measures and extrapolations.
The test is done in the laboratory on left-over serum from the standard H.I.V. test after it shows that a person is infected. The Food and Drug Administration has approved the test, known as BED.
Dr. Gerberding said that an earlier version of the new test was too crude to do the same kind of study earlier this decade. Despite the improvements in the test, she said, it is "not perfect yet."
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