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The Epidemiology of HIV and AIDS Worldwide, Nationwide, and in LA County Jane Neff Rollins, MSPH

The Epidemiology of HIV and AIDS Worldwide, Nationwide, and in LA County Jane Neff Rollins, MSPH. Spectrum of HIV Disease. ~10 years (without treatment). 6 weeks-- 6 months. Initial HIV Infection. Laboratory Evidence of Immuno-suppression. Opportunistic Disease (AIDS). Death.

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The Epidemiology of HIV and AIDS Worldwide, Nationwide, and in LA County Jane Neff Rollins, MSPH

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  1. The Epidemiology of HIV and AIDS Worldwide, Nationwide, and in LA County Jane Neff Rollins, MSPH

  2. Spectrum of HIV Disease ~10 years (without treatment) 6 weeks-- 6 months Initial HIV Infection Laboratory Evidenceof Immuno-suppression Opportunistic Disease (AIDS) Death HIV Antibody Test Positive Clinical Symptoms

  3. Signs and Symptoms of Acute HIV Infection Most Common • Fever • Lymphadenopathy • Sore throat • Extreme fatigue • Weight loss (more than 5 pounds in <2 weeks • Night sweats • Muscle and joint pain • Nausea or vomiting or diarrhea • Pain in feet or fingers • Thrush (yeast infection in the mouth or throat) • Red or dark, spotty, “measles-like” rash • Oral, genital or rectal ulcers Less Common Most Definitive Signs

  4. Healthcare workers with documented and possible occupationally acquired AIDS/HIV infection, reported through June, 2001, United States Documented Occupational Transmission Possible Occupational Transmission Occupation Dental worker, including dentist 6 Emergency med tech/paramedic --- 12 Lab technician 19 17 Nurse 24 35 Physician 6 18 Other 8 48 TOTAL 57 136 Source: www.cdc.gov/hiv/pubs/facts/hcwsurv.htm

  5. NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings, Publication # 2000-108 Available at www.cdc.gov/niosh or 1-800-35-NIOSH Recommendations for Prevention of HIV Transmission in Health Care Settings, MMWR, August 21, 1987, Vol 36: No 27,

  6. Primary and Secondary HIV Prevention Through Early Detection of HIV Infection Early Treatment Early Identification Partner Notification Reproductive Choices AZT/HAART during pregnancy Decreased Progression to AIDS Decreased Mortality Decreased Viral Load Altered Behaviors Decrease Vertical Transmission ? Decreased Transmission to Sex & Needle-Sharing Partners SECONDARY PREVENTION PRIMARY PREVENTION

  7. A global view of HIV infection36.1 million persons living with HIV/AIDS As of year-end 2000 Adult prevalence rate 15.0% – 36.0% 5.0% – 15.0% 1.0% – 5.0% 0.5% – 1.0% 0.1% – 0.5% 0.0% – 0.1% not available

  8. Spread of HIV over timein sub-Saharan Africa, 1984 to 1999 Estimated percentage of adults (15–49) infected with HIV 20.0% – 36.0% 10.0% – 20.0% 5.0% – 10.0% 1.0% – 5.0% 0.0% – 1.0% trend data unavailable outside region

  9. CD C Centers for Disease Control and Prevention AIDS Rates per 100,000 Population Reported in1999 6.3 3.4 VT 6.4 1.5 1.1 6.8 4.0 3.8 NH 2.0 2.9 42.3 23.5 2.2 MA 6.6 RI 10.8 3.1 17.9 3.0 16.4 CT 4.0 25.1 NJ 13.4 4.9 6.1 24.7 12.8 DE 7.3 3.8 29.5 MD 7.9 16.4 13.7 9.7 6.4 161.5 7.0 DC 10.4 13.8 18.4 4.4 5.3 7.6 24.7 21.5 10.9 15.2 15.9 Rate per 100,000 36.2 19.5 <5 2.4 5 - 14.9 8.4 15+ PR 32.1 VI 32.6

  10. CD C Centers for Disease Control and Prevention HIV Infection (not AIDS) Reported in 1999 N=21,419* 2 0 230 28 184 21 9 499 CT 5 169 79 232 NJ 1,330 919 301 64 325 49 † 287 878 472 1,017 897 694 219 717 Confidential HIV Reporting** 214 145 519 464 Required 2,563 971 Pediatric only 6,402 PR VI 153 *Includes 361 persons who were residents of areas without HIV infection surveillance but who were reported by areas with HIV infection surveillance. **HIV cases reported by patient name † HIV surveillance initiated in July 1999 Source: CDC

  11. CD C Centers for Disease Control and Prevention Age at Diagnosis of HIV Infection or AIDS, Reported through 1999, United States HIV* AIDS Number Percent Number Percent Age <13 2,026 2 8,718 1 13-19 4,797 4 3,725 1 20-29 41,178 34 123,580 17 30-39 47,613 39 329,066 45 40-49 20,263 17 190,087 26 50+ 6,730 5 78,198 11 122,607 733,374 *Data from 34 areas with confidential HIV infection surveillance

  12. CD C Centers for Disease Control and Prevention AIDS Cases in 13- to 19-Year-Olds by Race/Ethnicity, United States 29% 67% 14% 2% 2% 60% 5% 49% 14% 24% 20% 15% AIDS Cases 1999 AIDS Cases 1981-1999 U. S. Population N=312 N 27Million  N=3,725 White Black Hispanic Asian/Pacific Islander not Hispanic not Hispanic American Indian/ Alaska Native

  13. Public Health Importance of HIV/AIDS in LA County • LAC is second only to NYC in cumulative number of reported AIDS cases in metropolitan areas. • 35% of all California AIDS cases are reported from LAC. • Only 4 states (CA, TX, NY, FL) have reported more AIDS cases than LAC. Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

  14. Los Angeles County New York City Male Female Male Female Mode of HIV Exposure (%) of Cumulative AIDS Cases Los Angeles County vs. New York City MSM IDU MSM/IDU Hetero Transfusion Other/ undetermined 78 -- 6 26 7 -- 1 46 1 8 7 19 41 -- 44 52 n/a -- 3 31 <1 1 11 16 Source: HIV Epidemiology Program, LAC/DHS, and NYC Department of Health, as of 03/00

  15. HIV DISEASE IN LOS ANGELES COUNTY ~15,000Persons Living with AIDS AIDS HIV Infection Recognized ~25,000 Persons Living with HIV HIV Infection Unrecognized Estimated 40,000 individuals living with HIV Infection, both early and advanced (AIDS)

  16. AIDS Cases Reported in 1996-1999 By Gender, Race/Ethnicity, Exposure Category and Percentage Change 1996 1997 1998 1999 % change % change % change No. No. No. No. 96 to 97 97 to 98 98 to 99 GENDER Male 3165 2139 1813 1745 -32% -15% - 4% Female 342 269 221 212 -21% -18% - 4% RACE/ETHNICITY White 1672 919 663 667 -45% -28% + 1% AA 679 544 516 479 -20% - 5% - 7% Latino 1066 876 799 750 -18% - 9% - 6% Asian 71 50 49 50 -30% - 2% + 2% AI/AN 10 15 5 8 +50% -67% +60% EXPOSURE CATEGORY MSM 2448 1518 1125 1031 -38% -26% - 8% MSM/IDU 180 96 100 83 -47% + 4% -17% Male IDU 197 139 124 91 -29% -11% -27% Female IDU 96 71 37 34 -26% -48% - 8% Male Hetero 50 57 53 31 +14% - 7% -42% Female Hetero 167 128 94 76 -23% -27% -19% TOTAL 3507 2408 2034 1957 -31% -16% - 4% Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

  17. AIDS Deaths Reported in 1996-1999 By Gender, Race/Ethnicity, Exposure Category and Percentage Change 1996 1997 1998 1999 % change % change % change No. No. No. No. 96 to 97 97 to 98 98 to 99 GENDER Male 2038 965 623 518 -53% -35% -17% Female 175 100 84 75 -43% -16% -11% RACE/ETHNICITY White 1051 480 295 240 -54% -39% -19% AA 482 236 168 152 -51% -29% -10% Latino 623 317 236 182 -49% -26% - 23% Asian 50 24 5 14 -52% -79% +180 AI/AN 2 6 1 2 +200 -83% +100 EXPOSURE CATEGORY MSM 1565 691 420 336 -56% -39% -20% MSM/IDU 152 72 40 35 -53% -44% -13% Male IDU 146 75 45 40 -49% -40% -11% Female IDU 46 28 19 29 -39% -32% +53% Male Hetero 39 13 18 12 -67% +38% -33% Female Hetero 77 44 36 31 -43% -18% -14% TOTAL 2213 1065 707 593 -52% -34% -16% Source: HIV Epidemiology Program, LAC/DHS, as of 12/31/99

  18. Racial/Ethnic Distribution of Adult/Adolescent AIDS Cases by Year of Diagnosis Los Angeles County, 1986-2001 00 01 Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001

  19. Male Adolescent/Adult AIDS Rates1By Race/Ethnicity and Year of DiagnosisLos Angeles County, 1990-2001 1993 AIDS case definition change Rate per 100,000 00 0 Year of AIDS Diagnosis 1 Data are adjusted for reporting delay only. Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001

  20. Female Adolescent/Adult AIDS Rates1By Race/Ethnicity and Year of DiagnosisLos Angeles County, 1990-2001 1993 AIDS case definition change Rate per 100,000 0 0 Year of AIDS Diagnosis 1 Data are adjusted for reporting delay only. Source: HIV Epidemiology Program, LAC/ DHS, as of December, 2001

  21. AIDS Prevalence Rate (per 100,000)* for MalesBy Race/Ethnicity, 1986-1997, Los Angeles County * Prevalence Rate is the number of persons living with AIDS at any time during the year divided by the population in that year ( multiplied by 100,000) Source: HIV Epidemiology Program, LAC/ DHS, as of May 31, 1999

  22. AIDS Prevalence Rate (per 100,000)* for FemalesBy Race/Ethnicity, 1986-1997, Los Angeles County * Prevalence Rate is the number of persons living at any time during the year divided by the population in that year multiplied by 100,000 Source: HIV Epidemiology Program, LAC/ DHS, as of May 31, 1999

  23. Cases, Deaths and Case Fatality Rate of Advanced HIV Disease (AIDS) by Year , Reported by December 31, 2001, Los Angeles County Year Number of Cases Number of Deaths Case Fatality Diagnosed Occurred Rate 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2354 2804 3318 4015 4170 3944 3694 3460 2706 2088 1813 1595 1357 799 2229 2549 2943 3375 3197 2605 1965 1206 631 406 303 219 184 89 95% 91% 89% 84% 77% 66% 53% 35% 23% 19% 17% 14% 14% 11% 27114 43541 Source: HIV Epidemiology Program, LAC/DHS, as of 12/01

  24. AZT Treatment for HIV+ Pregnant Women AZT No AZT Number of births 180 183 Probability of HIV 8.3 25.5 Transmission (%) Source: NEJM, 331,1173-1180, November 3, 1994

  25. Median interval from first positive HIV test to AIDS diagnosis among a sample of persons reported with AIDS, 01/90-08/98 Los Angeles County, SHAS Interview project (N=2,377) Characteristics No. (%) Median Interval (months) 2002 (89.2) 14 375 (10.8) 14 881 (39.9) 32 433 (15.9) 8 1005 (41.0) 8 49 ( 2.6) 2 6 ( 0.5) 11 Sex Male Female Race/Ethnicity White Black Latino Asian Native-American Source: HIV Epidemiology Program, LAC/DHS

  26. Conclusions • Although Los Angeles is an area of high HIV prevalence, our findings indicate an overall low level of early HIV detection. • Major sociodemographic and behavioral disparities exist in the likelihood of early detection of HIV infection. • minorities, women, heterosexuals, young adults and persons of lower educational level are less likely have HIV detected early. • The low level of early HIV detection promotes transmission of HIV and may help explain the current local dynamics of HIV transmission in Los Angeles. Source: HIV Epidemiology Program, LAC/DHS

  27. HIV/AIDS and Tuberculosis Background • Increases in TB worldwide in recent years have been attributed in large part to the HIV epidemic • Immunocompromised persons such as those infected with HIV are at increased risk for tuberculosis Source: HIV Epidemiology Program, LAC/DHS

  28. HIV/AIDS and Tuberculosis The U.S. Centers for Disease Control and Prevention recommends that all persons with TB be tested for HIV so that: 1) HIV infections among persons with TB can be identified early to ensure the provision of high-quality medical care that considers the comanagement of both infections. 2) the extent of comorbidity of TB and HIV in the general population can be accurately assessed. Source: HIV Epidemiology Program, LAC-DHS

  29. The Los Angeles Syphilis Outbreak, 2000* • Of 111 cases of syphilis identified, 108 (97%) were from LAC, and 3 cases were from Long Beach • 13 primary, 43 secondary, 55 early latent stage • 103 (93%) identified as MSM, 7 (7%) as transgender • 58 (52%) were HIV positive • Among those, 42 (72%) were in care for HIV infection • The average age was 36 years of age (range 20-50) • 45% Latino, 41% white, 13% African-American, and 2% A/PI • Outbreak is suggestive evidence that there may be recent increases in high-risk behaviors for some MSM * Data of of 9/29/00 Source: Sexually Transmitted Disease (STD) Program, Los Angeles County Department of Health Services

  30. Young Men’s SurveyHIV prevalence Percent HIV+ Source: HIV Epidemiology Program, LAC/DHS

  31. YMS: Risk behaviors Source: HIV Epidemiology Program, LAC/DHS

  32. YMS:Risk behaviors (cont.) Source: HIV Epidemiology Program, LAC/DHS

  33. Jane Neff Rollins, MSPH jnrollins@hotmail.com

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