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CDC underestimated new HIV cases by 40 percent
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By MIKE STOBBE - 3 hours ago
ATLANTA (AP) Ñ 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.
The country had roughly 56,300 new HIV infections in 2006 Ñ 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. attention 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 news 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, advocates 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 estimate 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, health 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 good 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 dashboard in place," said the expert, David Holtgrave of Johns Hopkins University.
Judging by the new calculations, officials believe annual HIV infections have been hovering around 55,000 for several years.
"This is the most reliable estimate we've had since the beginning of the epidemic," said Dr. Julie Gerberding, the CDC's director. She said other countries may adopt the agency's methodology.
According to current 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 based on a blood test that for the first time can tell how recently an HIV infection occurred.
Past tests could detect only the presence of HIV, so determining which year an infection took place was guesswork Ñ guesswork upon which the old 40,000 estimate was based.
The new estimate relies on blood tests from 22 states where 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 real-time monitoring of HIV infections. Now, CDC officials say, the estimate will likely be updated every year.
Yearly estimates allow better recognition 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 finding, 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 continue 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 prevention efforts, particularly targeting younger gay and bisexual men.
For years, AIDS was considered a terrifying 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 signed 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 spending 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 "evidence 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 comes or not, the revised estimate clearly is a "wake-up call to scale things up," said Dr. Kevin Fenton, who oversees CDC's prevention efforts for HIV/AIDS.
Some said more attention 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 Institute 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 inadequately funding this epidemic all along. We need to step it up," said former U.S. Surgeon General Dr. 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 began working on the new methods nearly seven years ago.
Late last year, advocates said they had heard 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 statistical 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 diagnosed 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.
CDC, For Immediate Release
August 03, 2008
Contact: National Center for HIV/AIDS,
Hepatitis, STD and TB Prevention
404-639-8895
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."
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