HIV/AIDS Surveillance Report, Fourth Quarter 1992 Tuesday February 9, 1993 Suggested Citation: Centers for Disease Control. HIV/AIDS Surveillance Report, February 1993 Report Description The U.S. AIDS case data presented below are extracted from the "HIV/AIDS Surveillance Report", published each quarter by the Division of HIV/AIDS, Center for Infectious Diseases, Centers for Disease Control, and Prevention Atlanta, GA 30333. In addition to the data presented here, the printed report contains maps, figures, and technical notes. Single copies of the printed report are available free from: CDC National AIDS Clearinghouse P.O. Box 6003 Rockville, MD 20849-6003 Table 1. AIDS cases and annual rates per 100,000 population, by state, reported in 1991 and 1992; and cumulative totals, by state and age group, through December 1992 Jan. 1991- Jan.1992- Dec. 1991 Dec.1992 STATE OF RESIDENCE No. Rate No. Rate Alabama 375 9.2 437 10.6 Alaska 18 3.2 15 2.6 Arizona 282 7.5 386 10.2 Arkansas 195 8.2 280 11.7 California 7,700 25.3 8,539 27.8 Colorado 433 12.8 410 12.0 Connecticut 567 17.2 646 19.4 Delaware 87 12.8 140 20.4 District of Columbia 709 118.6 706 119.8 Florida 5,514 41.5 5,101 38.0 Georgia 1,454 22.0 1,324 19.8 Hawaii 197 17.4 138 12.0 Idaho 33 3.2 35 3.3 Illinois 1,602 13.9 1,912 16.4 Indiana 315 5.6 402 7.1 Iowa 81 2.9 111 3.9 Kansas 100 4.0 191 7.6 Kentucky 165 4.4 213 5.7 Louisiana 794 18.7 710 16.5 Maine 50 4.0 44 3.5 Maryland 969 19.9 1,204 24.5 Massachusetts 967 16.1 875 14.6 Michigan 619 6.6 718 7.6 Minnesota 216 4.9 218 4.9 Mississippi 198 7.6 260 9.9 Missouri 654 12.7 708 13.6 Montana 30 3.7 22 2.7 Nebraska 63 4.0 61 3.8 Nevada 262 20.4 249 19.2 New Hampshire 52 4.7 46 4.2 New Jersey 2,303 29.7 2,040 26.0 New Mexico 112 7.2 107 6.8 New York 8,152 45.1 8,398 46.0 North Carolina 600 8.9 584 8.6 North Dakota 5 0.8 5 0.8 Ohio 619 5.7 733 6.6 Oklahoma 189 6.0 272 8.5 Oregon 257 8.8 289 9.8 Pennsylvania 1,218 10.2 1,326 11.0 Rhode Island 92 9.2 106 10.4 South Carolina 335 9.4 391 10.9 South Dakota 4 0.6 8 1.1 Tennessee 351 7.1 408 8.1 Texas 3,067 17.7 2,920 16.6 Utah 135 7.6 135 7.5 Vermont 17 3.0 26 4.5 Virginia 679 10.8 784 12.3 Washington 572 11.4 551 10.9 West Virginia 62 3.4 54 3.0 Wisconsin 214 4.3 229 4.6 Wyoming 17 3.7 5 1.1 U.S. TOTAL 43,701 17.3 45,472 17.8 Guam 3 2.2 - 0.0 Pacific Islands, U.S. - 0.0 - 0.0 Puerto Rico 1,798 50.6 1,623 45.2 Virgin Islands, U.S. 22 21.5 11 10.7 TOTAL 45,524 17.9 47,106 18.3 Table 1. AIDS cases and annual rates per 100,000 population, by state, reported in 1991 and 1992; and cumulative totals, by state and age group, through December 1992 (Continued) Cumulative totals Adults/ Children STATE OF RESIDENCE adolescents <13 years old Total Alabama 1,664 38 1,702 Alaska 129 3 132 Arizona 1,931 12 1,943 Arkansas 913 17 930 California 46,502 316 46,818 Colorado 2,417 16 2,433 Connecticut 2,993 86 3,079 Delaware 532 7 539 District of Columbia 4,058 60 4,118 Florida 23,861 631 24,492 Georgia 6,968 76 7,044 Hawaii 956 7 963 Idaho 145 2 147 Illinois 8,110 119 8,229 Indiana 1,731 13 1,744 Iowa 418 5 423 Kansas 731 4 735 Kentucky 873 12 885 Louisiana 3,734 60 3,794 Maine 311 2 313 Maryland 5,183 124 5,307 Massachusetts 5,071 106 5,177 Michigan 3,286 57 3,343 Minnesota 1,252 12 1,264 Mississippi 1,095 20 1,115 Missouri 3,163 29 3,192 Montana 107 1 108 Nebraska 307 2 309 Nevada 1,128 13 1,141 New Hampshire 286 6 292 New Jersey 14,299 403 14,702 New Mexico 565 2 567 New York 49,832 1,153 50,985 North Carolina 2,791 63 2,854 North Dakota 29 - 29 Ohio 3,619 55 3,674 Oklahoma 1,158 15 1,173 Oregon 1,557 8 1,565 Pennsylvania 6,861 106 6,967 Rhode Island 570 9 579 South Carolina 1,754 31 1,785 South Dakota 36 1 37 Tennessee 1,844 20 1,864 Texas 17,180 183 17,363 Utah 593 16 609 Vermont 119 2 121 Virginia 3,451 74 3,525 Washington 3,386 18 3,404 West Virginia 293 4 297 Wisconsin 1,059 11 1,070 Wyoming 58 - 58 U.S. TOTAL 240,909 4,030 244,939 Guam 11 - 11 Pacific Islands, U.S. 2 - 2 Puerto Rico 8,171 214 8,385 Virgin Islands, U.S. 106 5 111 TOTAL 249,199 4,249 253,448 Table 2. AIDS cases and annual rates per 100,000 population, by metropolitan area with 500,000 or more population, reported in 1991 and 1992; and cumulative totals, by area and age group, through December 1992 Jan. 1991- Jan.1992- METROPOLITAN Dec. 1991 Dec.1992 AREA OF RESIDENCE No. Rate No. Rate Akron, Ohio 34 5.2 39 5.9 Albany-Schenectady, N.Y. 93 10.6 120 13.5 Allentown, Pa. 38 5.4 43 6.0 Anaheim, Calif. 427 17.4 489 19.7 Atlanta, Ga. 1,107 37.9 898 30.1 Austin, Tex. 202 24.9 256 30.8 Bakersfield, Calif. 51 9.1 51 9.0 Baltimore, Md. 579 24.0 764 31.5 Baton Rouge, La. 80 14.8 78 13.9 Bergen-Passaic, N.J. 247 19.3 267 20.9 Birmingham, Ala. 113 12.3 112 12.1 Boston, Mass. 685 18.2 596 15.9 Bridgeport, Conn. 155 18.8 167 20.0 Buffalo, N.Y. 77 8.0 80 8.3 Charleston, S.C. 67 12.9 79 15.0 Charlotte, N.C. 86 7.2 113 9.4 Chicago, Ill. 1,290 21.0 1,612 25.8 Cincinnati, Ohio 99 6.7 123 8.1 Cleveland, Ohio 181 9.9 185 10.2 Columbus, Ohio 116 8.2 180 12.4 Dallas, Tex. 706 26.9 686 25.7 Dayton, Ohio 57 5.9 59 6.0 Denver, Colo. 360 21.6 329 19.6 Detroit, Mich. 440 10.1 551 12.6 El Paso, Tex. 47 7.8 50 8.1 Fort Lauderdale, Fla. 946 73.8 855 66.3 Fort Worth, Tex. 195 14.2 173 12.3 Fresno, Calif. 78 11.4 91 13.1 Gary, Ind. 36 6.0 43 7.2 Grand Rapids, Mich. 41 5.8 32 4.3 Greensboro, N.C. 105 11.0 102 10.6 Greenville, S.C. 42 6.4 79 11.9 Harrisburg, Pa. 43 7.2 42 6.9 Hartford, Conn. 172 15.3 214 18.8 Honolulu, Hawaii 130 15.2 104 12.1 Houston, Tex. 1,198 35.5 1,026 30.0 Indianapolis, Ind. 145 11.3 166 12.6 Jacksonville, Fla. 232 25.0 340 36.4 Jersey City, N.J. 426 77.1 295 53.4 Kansas City, Mo. 237 14.9 295 18.3 Knoxville, Tenn. 35 5.7 28 4.5 Lake County, Ill. 40 7.5 29 5.3 Las Vegas, Nev. 201 25.3 186 23.0 Little Rock, Ark. 68 13.1 117 22.1 Los Angeles, Calif. 2,642 29.3 3,011 33.2 Louisville, Ky. 72 7.5 102 10.6 Memphis, Tenn. 103 10.3 163 16.1 Miami, Fla. 2,023 102.6 1,215 61.4 Middlesex, N.J. 196 19.0 216 20.4 Milwaukee, Wis. 107 7.4 128 8.7 Minneapolis-Saint Paul, Minn. 189 7.5 190 7.4 Monmouth-Ocean City, N.J. 160 16.0 127 12.4 Nashville, Tenn. 120 11.9 131 12.7 Nassau-Suffolk, N.Y. 342 13.1 419 15.9 New Bedford, Mass. 69 13.7 55 10.9 New Haven, Conn. 205 25.5 206 25.3 New Orleans, La. 478 38.6 381 30.8 New York, N.Y. 6,992 81.4 7,208 82.9 Newark, N.J. 937 51.5 797 44.0 Norfolk, Va. 142 10.0 167 11.6 Oakland, Calif. 439 20.7 550 25.8 Oklahoma City, Okla. 97 9.9 134 13.4 Omaha, Neb. 46 7.3 43 6.7 Orlando, Fla. 384 34.5 294 25.9 Oxnard-Ventura, Calif. 59 8.6 57 8.2 Philadelphia, Pa. 933 19.0 988 19.7 Phoenix, Ariz. 210 9.6 262 11.9 Pittsburgh, Pa. 108 5.3 155 7.7 Portland, Oreg. 195 15.2 232 17.9 Providence, R.I. 87 9.5 100 10.8 Raleigh-Durham, N.C. 134 17.7 91 11.8 Richmond, Va. 135 15.4 162 18.3 Riverside-San Bernardino, Calif. 354 13.1 444 16.0 Rochester, N.Y. 91 9.0 103 10.1 Sacramento, Calif. 228 15.0 273 17.7 Saint Louis, Mo. 362 14.7 332 13.3 Salt Lake City, Utah 116 10.5 121 10.9 San Antonio, Tex. 215 16.1 226 16.8 San Diego, Calif. 621 24.2 693 26.6 San Francisco, Calif. 1,968 121.8 2,125 131.7 San Jose, Calif. 186 12.3 174 11.4 San Juan, P.R. 1,069 62.6 1,026 59.5 Scranton, Pa. 40 5.4 41 5.4 Seattle, Wash. 408 20.0 411 19.8 Springfield, Mass. 104 17.3 105 17.6 Stockton, Calif. 65 13.2 34 6.8 Syracuse, N.Y. 39 5.9 71 10.6 Tacoma, Wash. 44 7.3 35 5.7 Tampa-Saint Petersburg, Fla. 529 25.0 638 29.9 Toledo, Ohio 38 6.2 33 5.4 Tucson, Ariz. 55 8.1 98 14.4 Tulsa, Okla. 62 8.6 82 11.1 Washington, D.C. 1,307 32.7 1,369 33.8 West Palm Beach, Fla. 404 45.2 523 57.4 Wichita, Kansas 24 4.9 67 13.3 Wilmington, Del. 67 11.4 116 19.5 Worcester, Mass. 55 7.7 69 9.7 METROPOLITAN AREAS WITH 500,000 OR MORE POPULATION 37,762 25.3 38,937 25.8 METROPOLITAN AREAS WITH 50,000 TO 500,000 POPULATION 4,842 10.0 5,003 10.2 NON-METROPOLITAN AREAS 2,734 4.8 2,992 5.2 TOTAL* 45,524 17.9 47,106 18.3 * Totals include 873 patients whose area of residence is unknown. Table 2. AIDS cases and annual rates per 100,000 population, by metropolitan area with 500,000 or more population, reported in 1991 and 1992; and cumulative totals, by area and age group, through December 1992 (Continued) Cumulative totals METROPOLITAN Adults/ Children AREA OF RESIDENCE adolescents <13 years old Total Akron, Ohio 179 - 179 Albany-Schenectady, N.Y. 525 12 537 Allentown, Pa. 235 6 241 Anaheim, Calif. 2,216 15 2,231 Atlanta, Ga. 5,232 37 5,269 Austin, Tex. 1,166 12 1,178 Bakersfield, Calif. 215 2 217 Baltimore, Md. 3,148 98 3,246 Baton Rouge, La. 350 4 354 Bergen-Passaic, N.J. 1,818 47 1,865 Birmingham, Ala. 501 8 509 Boston, Mass. 3,798 75 3,873 Bridgeport, Conn. 855 27 882 Buffalo, N.Y. 413 4 417 Charleston, S.C. 380 3 383 Charlotte, N.C. 525 9 534 Chicago, Ill. 6,786 99 6,885 Cincinnati, Ohio 570 9 579 Cleveland, Ohio 941 16 957 Columbus, Ohio 794 6 800 Dallas, Tex. 4,163 24 4,187 Dayton, Ohio 352 7 359 Denver, Colo. 1,980 11 1,991 Detroit, Mich. 2,350 41 2,391 El Paso, Tex. 204 1 205 Fort Lauderdale, Fla. 4,184 92 4,276 Fort Worth, Tex. 997 12 1,009 Fresno, Calif. 358 2 360 Gary, Ind. 172 1 173 Grand Rapids, Mich. 174 2 176 Greensboro, N.C. 454 11 465 Greenville, S.C. 246 1 247 Harrisburg, Pa. 243 5 248 Hartford, Conn. 925 17 942 Honolulu, Hawaii 714 4 718 Houston, Tex. 6,926 73 6,999 Indianapolis, Ind. 786 4 790 Jacksonville, Fla. 1,318 43 1,361 Jersey City, N.J. 2,398 69 2,467 Kansas City, Mo. 1,520 6 1,526 Knoxville, Tenn. 174 1 175 Lake County, Ill. 139 3 142 Las Vegas, Nev. 845 13 858 Little Rock, Ark. 363 8 371 Los Angeles, Calif. 16,382 136 16,518 Louisville, Ky. 374 6 380 Memphis, Tenn. 617 6 623 Miami, Fla. 7,230 222 7,452 Middlesex, N.J. 1,210 29 1,239 Milwaukee, Wis. 584 7 591 Minneapolis-Saint Paul, Minn. 1,109 9 1,118 Monmouth-Ocean City, N.J. 933 32 965 Nashville, Tenn. 607 9 616 Nassau-Suffolk, N.Y. 2,327 58 2,385 New Bedford, Mass. 273 8 281 New Haven, Conn. 970 40 1,010 New Orleans, La. 2,272 32 2,304 New York, N.Y. 43,219 1,035 44,254 Newark, N.J. 5,896 177 6,073 Norfolk, Va. 747 22 769 Oakland, Calif. 3,020 24 3,044 Oklahoma City, Okla. 586 1 587 Omaha, Neb. 216 1 217 Orlando, Fla. 1,397 20 1,417 Oxnard-Ventura, Calif. 263 1 264 Philadelphia, Pa. 5,179 76 5,255 Phoenix, Ariz. 1,396 8 1,404 Pittsburgh, Pa. 811 4 815 Portland, Oreg. 1,226 5 1,231 Providence, R.I. 537 8 545 Raleigh-Durham, N.C. 575 13 588 Richmond, Va. 679 12 691 Riverside-San Bernardino, Calif. 1,793 23 1,816 Rochester, N.Y. 531 8 539 Sacramento, Calif. 1,132 13 1,145 Saint Louis, Mo. 1,497 19 1,516 Salt Lake City, Utah 523 12 535 San Antonio, Tex. 1,229 12 1,241 San Diego, Calif. 3,607 26 3,633 San Francisco, Calif. 13,448 25 13,473 San Jose, Calif. 1,062 8 1,070 San Juan, P.R. 5,079 135 5,214 Scranton, Pa. 203 4 207 Seattle, Wash. 2,543 10 2,553 Springfield, Mass. 398 15 413 Stockton, Calif. 217 8 225 Syracuse, N.Y. 264 6 270 Tacoma, Wash. 226 8 234 Tampa-Saint Petersburg, Fla. 2,618 49 2,667 Toledo, Ohio 186 3 189 Tucson, Ariz. 391 3 394 Tulsa, Okla. 340 5 345 Washington, D.C. 7,157 102 7,259 West Palm Beach, Fla. 2,250 93 2,343 Wichita, Kansas 190 2 192 Wilmington, Del. 438 6 444 Worcester, Mass. 301 4 305 METROPOLITAN AREAS WITH 500,000 OR MORE POPULATION 210,890 3,540 214,430 METROPOLITAN AREAS WITH 50,000 TO 500,000 POPULATION 23,684 416 24,100 NON-METROPOLITAN AREAS 13,772 273 14,045 TOTAL* 249,199 4,249 253,448 * Totals include 873 patients whose area of residence is unknown. Table 3. AIDS cases by age group, exposure category, and sex, reported in 1991 and 1992; and cumulative totals, by age group and exposure category, through December 1992, United States Males Jan. 1991- Jan. 1992- ADULT/ADOLESCENT Dec. 1991 Dec. 1992 EXPOSURE CATEGORY No. (%) No. (%) Men who have sex with men 24,216 (62) 23,936 (60) Injecting drug use 8,494 (22) 8,610 (21) Men who have sex with men and inject drugs 2,551 (7) 2,429 (6) Hemophilia/coagulation disorder 308 (1) 313 (1) Heterosexual contact: 1,327 (3) 1,677 (4) Sex with injecting drug user 573 688 Sex with bisexual male - - Sex with person with hemophilia 4 2 Born in Pattern-II* country 325 283 Sex with person born in Pattern-II country 22 17 Sex with transfusion recipient with HIV infection 27 20 Sex with person with HIV infection, risk not specified 376 667 Receipt of blood transfusion, blood components, or tissue** 442 (1) 397 (1) Other/undetermined*** 1,762 (5) 2,718 (7) Adult/adolescent subtotal 39,100 (100) 40,080 (100) PEDIATRIC (<13 years old) EXPOSURE CATEGORY Hemophilia/coagulation disorder 24 (6) 21 (6) Mother with/at risk for HIV infection: 324 (87) 330 (87) Injecting drug use 141 111 Sex with injecting drug user 58 51 Sex with bisexual male 6 5 Sex with person with hemophilia 4 4 Born in Pattern-II country 23 17 Sex with person born in Pattern-II country 1 2 Sex with transfusion recipient with HIV infection - 1 Sex with person with HIV infection, risk not specified 27 30 Receipt of blood transfusion, blood components, or tissue 6 16 Has HIV infection, risk not specified 58 93 Receipt of blood transfusion, blood components, or tissue 19 (5) 14 (4) Other/undetermined 4 (1) 16 (4) Pediatric subtotal 371 (100) 381 (100) TOTAL 39,471 40,461 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupa- tional exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 3. AIDS cases by age group, exposure category, and sex, reported in 1991 and 1992; and cumulative totals, by age group and exposure category, through December 1992, United States (Continued) Females Jan. 1991- Jan. 1992- ADULT/ADOLESCENT Dec. 1991 Dec. 1992 EXPOSURE CATEGORY No. (%) No. (%) Men who have sex with men - (0) - (0) Injecting drug use 2,820 (49) 2,815 (45) Men who have sex with men and inject drugs - (0) - (0) Hemophilia/coagulation disorder 8 (0) 3 (0) Heterosexual contact: 2,185 (38) 2,437 (39) Sex with injecting drug user 1,291 1,321 Sex with bisexual male 163 151 Sex with person with hemophilia 21 23 Born in Pattern-II* country 168 170 Sex with person born in Pattern-II country 25 10 Sex with transfusion recipient with HIV infection 57 48 Sex with person with HIV infection, risk not specified 460 714 Receipt of blood transfusion, blood components, or tissue** 253 (4) 276 (4) Other/undetermined*** 466 (8) 724 (12) Adult/adolescent subtotal 5,732 (100) 6,255 (100) PEDIATRIC (<13 years old) EXPOSURE CATEGORY Hemophilia/coagulation disorder 1 (0) - (0) Mother with/at risk for HIV infection: 290 (90) 367 (94) Injecting drug use 128 135 Sex with injecting drug user 55 58 Sex with bisexual male 7 7 Sex with person with hemophilia - 3 Born in Pattern-II country 12 15 Sex with person born in Pattern-II country - 3 Sex with transfusion recipient with HIV infection 1 3 Sex with person with HIV infection, risk not specified 14 41 Receipt of blood transfusion, blood components, or tissue 7 8 Has HIV infection, risk not specified 66 94 Receipt of blood transfusion, blood components, or tissue 20 (6) 5 (1) Other/undetermined 10 (3) 18 (5) Pediatric subtotal 321 (100) 390 (100) TOTAL 6,053 6,645 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupa- tional exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 3. AIDS cases by age group, exposure category, and sex, reported in 1991 and 1992; and cumulative totals, by age group and exposure category, through December 1992, United States (Continued) Totals Jan. 1991- Jan. 1992- Cumulative ADULT/ADOLESCENT Dec. 1991 Dec. 1992 Total**** EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 24,216 (54) 23,936 (52) 142,626 (57) Injecting drug use 11,314 (25) 11,425 (25) 57,412 (23) Men who have sex with men and inject drugs 2,551 (6) 2,429 (5) 15,899 (6) Hemophilia/coagulation disorder 316 (1) 316 (1) 2,026 (1) Heterosexual contact: 3,512 (8) 4,114 (9) 16,254 (7) Sex with injecting drug user 1,864 2,009 8,481 Sex with bisexual male 163 151 823 Sex with person with hemophilia 25 25 131 Born in Pattern-II* country 493 453 2,962 Sex with person born in Pattern-II country 47 27 205 Sex with transfusion recipient with HIV infection 84 68 311 Sex with person with HIV infection, risk not specified 836 1,381 3,341 Receipt of blood transfusion, blood components, or tissue** 695 (2) 673 (1) 4,980 (2) Other/undetermined*** 2,228 (5) 3,442 (7) 10,002 (4) Adult/adolescent subtotal 44,832 (100) 46,335 (100) 249,199 (100) PEDIATRIC (<13 years old) EXPOSURE CATEGORY Hemophilia/coagulation disorder 25 (4) 21 (3) 188 (4) Mother with/at risk for HIV infection: 614 (89) 697 (90) 3,665 (86) Injecting drug use 269 246 1,698 Sex with injecting drug user 113 109 722 Sex with bisexual male 13 12 79 Sex with person with hemophilia 4 7 20 Born in Pattern-II country 35 32 278 Sex with person born in Pattern-II country 1 5 18 Sex with transfusion recipient with HIV infection 1 4 17 Sex with person with HIV infection, risk not specified 41 71 211 Receipt of blood transfusion, blood components, or tissue 13 24 80 Has HIV infection, risk not specified 124 187 542 Receipt of blood transfusion, blood components, or tissue 39 (6) 19 (2) 306 (7) Other/undetermined 14 (2) 34 (4) 90 (2) Pediatric subtotal 692 (100) 771 (100) 4,249 (100) TOTAL 45,524 47,106 253,448 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupa- tional exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. **** Includes 6 patients known to be infected with human immunodeficiency virus type 2 (HIV-2). See "Human Immunodeficiency Virus Type 2 Infection in the United States." O'Brien TR, George JR, Holmberg SD. JAMA, May 27, 1992, Vol. 267, No. 20, pp. 2775-2779. Table 4. AIDS cases by age group, exposure category, and race/ethnicity, reported through December 1992, United States White, not Black, not ADULT/ADOLESCENT Hispanic Hispanic Hispanic EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 99,016 (75) 25,547 (35) 16,342 (40) Injecting drug use 11,796 (9) 28,960 (39) 16,397 (40) Men who have sex with men and inject drugs 9,044 (7) 4,407 (6) 2,334 (6) Hemophilia/coagulation disorder 1,651 (1) 167 (0) 169 (0) Heterosexual contact: 3,396 (3) 9,583 (13) 3,161 (8) Sex with injecting drug user 1,755 4,501 2,173 Sex with bisexual male 425 276 101 Sex with person with hemophilia 104 17 8 Born in Pattern-II* country 10 2,926 17 Sex with person born in Pattern-II country 55 135 14 Sex with transfusion recipient with HIV infection 183 62 61 Sex with person with HIV infection, risk not specified 864 1,666 787 Receipt of blood transfusion, blood components, or tissue** 3,371 (3) 909 (1) 578 (1) Other/undetermined*** 3,480 (3) 4,113 (6) 2,191 (5) Adult/adolescent subtotal 131,754 (100) 73,686 (100) 41,172 (100) PEDIATRIC (<13 years old) EXPOSURE CATEGORY Hemophilia/coagulation disorder 129 (15) 25 (1) 30 (3) Mother with/at risk for HIV infection: 566 (65) 2,163 (94) 908 (88) Injecting drug use 257 1,001 429 Sex with injecting drug user 106 331 280 Sex with bisexual male 34 27 17 Sex with person with hemophilia 12 5 3 Born in Pattern-II country 3 273 2 Sex with person born in Pattern-II country - 16 1 Sex with transfusion recipient with HIV infection 6 4 7 Sex with person with HIV infection, risk not specified 41 110 56 Receipt of blood transfusion, blood components, or tissue 24 36 20 Has HIV infection, risk not specified 83 360 93 Receipt of blood transfusion, blood components, or tissue 158 (18) 68 (3) 72 (7) Other/undetermined 18 (2) 55 (2) 17 (2) Pediatric subtotal 871 (100) 2,311 (100) 1,027 (100) TOTAL 132,625 75,997 42,199 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupa- tional exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 4. AIDS cases by age group, exposure category, and race/ethnicity, reported through December 1992, United States (Continued) American Asian/ Indian/ Pacific Alaska ADULT/ADOLESCENT Islander Native Total**** EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 1,161 (73) 240 (55) 142,626 (57) Injecting drug use 69 (4) 77 (18) 57,412 (23) Men who have sex with men and inject drugs 36 (2) 61 (14) 15,899 (6) Hemophilia/coagulation disorder 24 (2) 9 (2) 2,026 (1) Heterosexual contact: 68 (4) 19 (4) 16,254 (7) Sex with injecting drug user 24 13 8,481 Sex with bisexual male 16 3 823 Sex with person with hemophilia 2 - 131 Born in Pattern-II* country 3 - 2,962 Sex with person born in Pattern-II country 1 - 205 Sex with transfusion recipient with HIV infection 3 - 311 Sex with person with HIV infection, risk not specified 19 3 3,341 Receipt of blood transfusion, blood components, or tissue** 105 (7) 7 (2) 4,980 (2) Other/undetermined*** 128 (8) 22 (5) 10,002 (4) Adult/adolescent subtotal 1,591 (100) 435 (100) 249,199 (100) PEDIATRIC (<13 years old) EXPOSURE CATEGORY Hemophilia/coagulation disorder 3 (16) 1 (8) 188 (4) Mother with/at risk for HIV infection: 9 (47) 12 (92) 3,665 (86) Injecting drug use 3 5 1,698 Sex with injecting drug user 2 1 722 Sex with bisexual male 1 - 79 Sex with person with hemophilia - - 20 Born in Pattern-II country - - 278 Sex with person born in Pattern-II country - - 18 Sex with transfusion recipient with HIV infection - - 17 Sex with person with HIV infection, risk not specified 1 2 211 Receipt of blood transfusion, blood components, or tissue - - 80 Has HIV infection, risk not specified 2 4 542 Receipt of blood transfusion, blood components, or tissue 7 (37) - (0) 306 (7) Other/undetermined - (0) - (0) 90 (2) Pediatric subtotal 19 (100) 13 (100) 4,249 (100) TOTAL 1,610 448 253,448 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. **** Includes 569 persons whose race/ethnicity is unknown. Table 5. Adult/adolescent AIDS cases by sex, exposure category, and race/ethnicity, reported through December 1992, United States White, not Black, not MALE Hispanic Hispanic Hispanic EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 99,016 (79) 25,547 (43) 16,342 (46) Injecting drug use 8,895 (7) 21,100 (36) 13,613 (38) Men who have sex with men and inject drugs 9,044 (7) 4,407 (7) 2,334 (7) Hemophilia/coagulation disorder 1,619 (1) 159 (0) 166 (0) Heterosexual contact: 1,121 (1) 4,392 (7) 881 (2) Sex with injecting drug user 616 1,522 438 Sex with person with hemophilia 7 3 2 Born in Pattern-II* country 8 2,050 10 Sex with person born in Pattern-II country 44 59 11 Sex with transfusion recipient with HIV infection 49 26 23 Sex with person with HIV infection, risk not specified 397 732 397 Receipt of blood transfusion, blood components, or tissue** 2,170 (2) 490 (1) 307 (1) Other/undetermined*** 2,962 (2) 3,040 (5) 1,784 (5) Male subtotal 124,827 (100) 59,135 (100) 35,427 (100) FEMALE EXPOSURE CATEGORY Injecting drug use 2,901 (42) 7,860 (54) 2,784 (48) Hemophilia/coagulation disorder 32 (0) 8 (0) 3 (0) Heterosexual contact: 2,275 (33) 5,191 (36) 2,280 (40) Sex with injecting drug user 1,139 2,979 1,735 Sex with bisexual male 425 276 101 Sex with person with hemophilia 97 14 6 Born in Pattern-II country 2 876 7 Sex with person born in Pattern-II country 11 76 3 Sex with transfusion recipient with HIV infection 134 36 38 Sex with person with HIV infection, risk not specified 467 934 390 Receipt of blood transfusion, blood components, or tissue 1,201 (17) 419 (3) 271 (5) Other/undetermined 518 (7) 1,073 (7) 407 (7) Female subtotal 6,927 (100) 14,551 (100) 5,745 (100) TOTAL 131,754 73,686 41,172 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 5. Adult/adolescent AIDS cases by sex, exposure category, and race/ethnicity, reported through December 1992, United States (Continued) American Asian/ Indian/ Pacific Alaska MALE Islander Native Total**** EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 1,161 (80) 240 (64) 142,626 (64) Injecting drug use 50 (3) 42 (11) 43,786 (20) Men who have sex with men and inject drugs 36 (2) 61 (16) 15,899 (7) Hemophilia/coagulation disorder 24 (2) 9 (2) 1,983 (1) Heterosexual contact: 14 (1) 4 (1) 6,419 (3) Sex with injecting drug user 6 3 2,585 Sex with person with hemophilia - - 12 Born in Pattern-II* country 3 - 2,076 Sex with person born in Pattern-II country 1 - 115 Sex with transfusion recipient with HIV infection - - 99 Sex with person with HIV infection, risk not specified 4 1 1,532 Receipt of blood transfusion, blood components, or tissue** 60 (4) 2 (1) 3,036 (1) Other/undetermined*** 103 (7) 16 (4) 7,965 (4) Male subtotal 1,448 (100) 374 (100) 221,714 (100) FEMALE EXPOSURE CATEGORY Injecting drug use 19 (13) 35 (57) 13,626 (50) Hemophilia/coagulation disorder - (0) - (0) 43 (0) Heterosexual contact: 54 (38) 15 (25) 9,835 (36) Sex with injecting drug user 18 10 5,896 Sex with bisexual male 16 3 823 Sex with person with hemophilia 2 - 119 Born in Pattern-II country - - 886 Sex with person born in Pattern-II country - - 90 Sex with transfusion recipient with HIV infection 3 - 212 Sex with person with HIV infection, risk not specified 15 2 1,809 Receipt of blood transfusion, blood components, or tissue 45 (31) 5 (8) 1,944 (7) Other/undetermined 25 (17) 6 (10) 2,037 (7) Female subtotal 143 (100) 61 (100) 27,485 (100) TOTAL 1,591 435 249,199 * See technical notes (available only in the printed version of this report). ** Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. *** "Other" refers to 7 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. **** Includes 503 males and 58 females whose race/ethnicity is unknown. Table 6. AIDS cases in adolescents and adults under age 25, by exposure category, reported in 1991 and 1992; and cumulative totals through December 1992, United States 13-19 years old Jan. 1991- Jan. 1992- Cumulative Dec. 1991 Dec. 1992 Total EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 34 (21) 30 (19) 228 (24) Injecting drug use 26 (16) 14 (9) 122 (13) Men who have sex with men and inject drugs 3 (2) 4 (3) 37 (4) Hemophilia/coagulation disorder 48 (30) 41 (26) 282 (30) Heterosexual contact: 25 (16) 41 (26) 150 (16) Sex with injecting drug user 14 23 96 Sex with bisexual male 1 - 4 Sex with person with hemophilia 3 1 5 Born in Pattern-II* country 1 1 14 Sex with person born in Pattern-II country 2 - 2 Sex with transfusion recipient with HIV infection - - 1 Sex with person with HIV infection, risk not specified 4 16 28 Receipt of blood transfusion, blood components, or tissue 8 (5) 5 (3) 57 (6) Undetermined** 15 (9) 24 (15) 70 (7) TOTAL 159 (100) 159 (100) 946 (100) * See technical notes (available only in the printed version of this report). ** "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 6. AIDS cases in adolescents and adults under age 25, by exposure category, reported in 1991 and 1992; and cumulative totals through December 1992, United States (Continued) 20-24 years old Jan. 1991- Jan. 1992- Cumulative Dec. 1991 Dec. 1992 Total EXPOSURE CATEGORY No. (%) No. (%) No. (%) Men who have sex with men 675 (46) 687 (48) 5,141 (54) Injecting drug use 306 (21) 234 (16) 1,645 (17) Men who have sex with men and inject drugs 117 (8) 79 (5) 833 (9) Hemophilia/coagulation disorder 38 (3) 38 (3) 247 (3) Heterosexual contact: 218 (15) 254 (18) 1,134 (12) Sex with injecting drug user 128 123 627 Sex with bisexual male 13 10 76 Sex with person with hemophilia 2 3 21 Born in Pattern-II* country 15 15 139 Sex with person born in Pattern-II country 2 1 12 Sex with transfusion recipient with HIV infection 3 1 11 Sex with person with HIV infection, risk not specified 55 101 248 Receipt of blood transfusion, blood components, or tissue 20 (1) 15 (1) 129 (1) Undetermined** 100 (7) 139 (10) 453 (5) TOTAL 1,474 (100) 1,446 (100) 9,582 (100) * See technical notes (available only in the printed version of this report). ** "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. Table 7. AIDS cases by sex, age at diagnosis, and race/ethnicity, reported through December 1992, United States White, not Black, not MALE Hispanic Hispanic Hispanic AGE AT DIAGNOSIS (YEARS) No. (%) No. (%) No. (%) Under 5 298 (0) 1,013 (2) 426 (1) 5-12 221 (0) 154 (0) 121 (0) 13-19 309 (0) 209 (0) 140 (0) 20-24 3,797 (3) 2,434 (4) 1,510 (4) 25-29 18,340 (15) 8,966 (15) 5,844 (16) 30-34 29,167 (23) 14,264 (24) 8,873 (25) 35-39 27,732 (22) 14,083 (23) 7,980 (22) 40-44 19,623 (16) 8,882 (15) 5,159 (14) 45-49 11,609 (9) 4,720 (8) 2,745 (8) 50-54 6,287 (5) 2,627 (4) 1,521 (4) 55-59 3,770 (3) 1,512 (3) 896 (2) 60-64 2,259 (2) 822 (1) 445 (1) 65 or older 1,934 (2) 616 (1) 314 (1) Male subtotal 125,346 (100) 60,302 (100) 35,974 (100) FEMALES AGE AT DIAGNOSIS (YEARS) Under 5 285 (4) 992 (6) 392 (6) 5-12 67 (1) 152 (1) 88 (1) 13-19 73 (1) 152 (1) 47 (1) 20-24 433 (6) 892 (6) 419 (7) 25-29 1,294 (18) 2,660 (17) 1,224 (20) 30-34 1,595 (22) 3,901 (25) 1,497 (24) 35-39 1,171 (16) 3,349 (21) 1,184 (19) 40-44 695 (10) 1,779 (11) 651 (10) 45-49 377 (5) 769 (5) 298 (5) 50-54 259 (4) 450 (3) 185 (3) 55-59 265 (4) 260 (2) 107 (2) 60-64 210 (3) 162 (1) 61 (1) 65 or older 555 (8) 177 (1) 72 (1) Female subtotal 7,279 (100) 15,695 (100) 6,225 (100) TOTAL 132,625 75,997 42,199 Table 7. AIDS cases by sex, age at diagnosis, and race/ethnicity, reported through December 1992, United States (Continued) American Asian/ Indian/ Pacific Alaska MALE Islander Native Total* AGE AT DIAGNOSIS (YEARS) No. (%) No. (%) No. (%) Under 5 7 (0) 8 (2) 1,754 (1) 5-12 6 (0) 1 (0) 503 (0) 13-19 7 (0) 6 (2) 671 (0) 20-24 48 (3) 19 (5) 7,820 (3) 25-29 203 (14) 79 (21) 33,503 (15) 30-34 289 (20) 103 (27) 52,809 (24) 35-39 317 (22) 75 (20) 50,309 (22) 40-44 249 (17) 48 (13) 34,047 (15) 45-49 162 (11) 22 (6) 19,303 (9) 50-54 77 (5) 8 (2) 10,547 (5) 55-59 48 (3) 6 (2) 6,251 (3) 60-64 15 (1) 7 (2) 3,553 (2) 65 or older 33 (2) 1 (0) 2,901 (1) Male subtotal 1,461 (100) 383 (100) 223,971 (100) FEMALES AGE AT DIAGNOSIS (YEARS) Under 5 - (0) 4 (6) 1,678 (6) 5-12 6 (4) - (0) 314 (1) 13-19 1 (1) 1 (2) 275 (1) 20-24 7 (5) 5 (8) 1,762 (6) 25-29 10 (7) 12 (18) 5,210 (18) 30-34 28 (19) 20 (31) 7,056 (24) 35-39 20 (13) 7 (11) 5,744 (19) 40-44 31 (21) 8 (12) 3,169 (11) 45-49 15 (10) 4 (6) 1,468 (5) 50-54 7 (5) 1 (2) 903 (3) 55-59 7 (5) - (0) 640 (2) 60-64 9 (6) 2 (3) 444 (2) 65 or older 8 (5) 1 (2) 814 (3) Female subtotal 149 (100) 65 (100) 29,477 (100) TOTAL 1,610 448 253,448 * Includes 569 persons whose race/ethnicity is unknown. Table 8. AIDS cases, case-fatality rates, and deaths by half-year and age group, through December 1992, United States Adults/adolescents Cases diagnosed Case-fatality Deaths occuring HALF-YEAR during interval rate during interval Before 1981 81 86.4 30 1981 Jan.-June 92 91.3 39 July-Dec. 203 91.1 87 1982 Jan.-June 397 93.5 152 July-Dec. 696 91.4 289 1983 Jan.-June 1,288 93.6 525 July-Dec. 1,647 93.3 933 1984 Jan.-June 2,567 92.6 1,402 July-Dec. 3,389 93.0 1,970 1985 Jan.-June 4,896 92.5 2,826 July-Dec. 6,331 91.4 3,880 1986 Jan.-June 8,317 90.4 5,098 July-Dec. 9,950 88.1 6,551 1987 Jan.-June 12,951 88.4 7,592 July-Dec. 14,362 85.2 7,976 1988 Jan.-June 16,500 82.7 9,353 July-Dec. 16,980 81.8 10,690 1989 Jan.-June 19,268 77.0 12,461 July-Dec. 19,310 74.5 14,302 1990 Jan.-June 20,550 68.0 13,923 July-Dec. 19,748 61.6 14,760 1991 Jan.-June 21,404 52.9 15,171 July-Dec. 20,467 42.6 16,210 1992 Jan.-June 18,520 28.7 14,915 July-Jan. 9,285 15.4 8,261 TOTAL* 249,199 68.1 169,623 * Death totals include 227 adults/adolescents and 5 children known to have died, but whose dates of death are unknown. Table 8. AIDS cases, case-fatality rates, and deaths by half-year and age group, through December 1992, United States (Continued) Children <13 years old Cases diagnosed Case-fatality Deaths occuring HALF-YEAR during interval rate during interval Before 1981 6 66.7 1 1981 Jan.-June 10 80.0 2 July-Dec. 5 100.0 7 1982 Jan.-June 14 85.7 8 July-Dec. 15 80.0 5 1983 Jan.-June 33 100.0 13 July-Dec. 42 88.1 16 1984 Jan.-June 49 85.7 26 July-Dec. 61 85.2 22 1985 Jan.-June 97 77.3 44 July-Dec. 130 80.8 70 1986 Jan.-June 135 83.0 64 July-Dec. 187 70.6 92 1987 Jan.-June 222 71.6 118 July-Dec. 260 66.2 168 1988 Jan.-June 252 64.7 134 July-Dec. 336 58.9 173 1989 Jan.-June 342 58.2 168 July-Dec. 332 51.2 185 1990 Jan.-June 347 46.7 189 July-Dec. 363 38.3 188 1991 Jan.-June 326 36.8 155 July-Dec. 275 26.2 179 1992 Jan.-June 297 22.6 151 July-Jan. 113 15.0 84 Total1 4,249 53.4 2,267 * Death totals include 227 adults/adolescents and 5 children known to have died, but whose dates of death are unknown. Table 9. AIDS cases by year of diagnosis and definition category, diagnosed through December 1992, United States Year of diagnosis Before Jan. 1989- Jan. 1990- Jan. 1989 Dec. 1989 Dec. 1990 DEFINITION CATEGORY* No. (%) No. (%) No. (%) Pre-1987 definition 84,889 (83) 27,365 (70) 27,268 (66) 1987 definition: 17,612 (17) 11,887 (30) 13,740 (34) Specific disease presumptively diagnosed 9,796 6,904 8,617 Specific disease definitively diagnosed 1,552 790 854 HIV encephalopathy 2,144 1,375 1,412 HIV wasting syndrome 4,120 2,818 2,857 TOTAL 102,501 (100) 39,252 (100) 41,008 (100) * Persons who meet the criteria for more than one definition category are classified in the definition category listed first. Table 9. AIDS cases by year of diagnosis and definition category, diagnosed through December 1992, United States (Continued) Year of diagnosis Jan. 1991- Jan. 1992- Cumulative Dec. 1991 Dec. 1992 total DEFINITION CATEGORY* No. (%) No. (%) No. (%) Pre-1987 definition 27,002 (64) 16,824 (60) 183,348 (72) 1987 definition: 15,470 (36) 11,391 (40) 70,100 (28) Specific disease presumptively diagnosed 9,528 6,781 41,626 Specific disease definitively diagnosed 913 607 4,716 HIV encephalopathy 1,459 1,010 7,400 HIV wasting syndrome 3,570 2,993 16,358 TOTAL 42,472 (100) 28,215 (100) 253,448 (100) * Persons who meet the criteria for more than one definition category are classified in the definition category listed first. Table 10. Health-care workers with HIV infection and/or AIDS, with documented and possible occupationally acquired HIV infection, by occupation, reported through June 1992, United States* Documented Possible occupational occupational transmission** transmission*** Occupation No. No. Dental worker, including dentist - 6 Embalmer/morgue technician - 3 Emergency medical technician/paramedic - 7 Health aide/attendant 1 5 Housekeeper/maintenance worker 1 5 Laboratory technician, clinical 12 12 Laboratory technician, nonclinical 1 1 Nurse 12 14 Physician, nonsurgical 4 7 Physician, surgical - 2 Respiratory therapist 1 1 Surgical technician 1 1 Technician/therapist, other than those listed above - 3 Other health care occupations - 2 Total 33 69 * Health-care workers are defined as those persons, including students and trainees, who have worked in a health-care, clinical, or HIV laboratory setting at any time since 1978. ** Health-care workers who had documented HIV seroconversion after occupational exposure: 28 had percutaneous exposure, 4 had mucocutaneous exposure, 1 had both percutaneous and mucocutaneous exposures. Thirty exposures were to HIV-infected blood, 1 to visibly blood fluid, 1 to an unspecified fluid and 1 to concentrated virus in a laboratory. Seven have developed AIDS. *** These health-care workers have been investigated and are without identifiable behavioral or transfusion risks; each reported percutaneous or mucocutaneous occupational exposures to blood or body fluids, or laboratory specimens containing HIV, but HIV seroconversion was not documented. Table 11. Adult/adolescent AIDS cases by single and multiple exposure categories reported through December 1992, United States AIDS cases EXPOSURE CATEGORY No. (%) Men who have sex with men 137,401 (55) Injecting drug use 48,818 (20) Hemophilia/coagulation disorder 1,388 (1) Heterosexual contact 15,645 (6) Receipt of blood transfusion, blood component, or tissue* 4,980 (2) Other/undetermined** 10,002 (4) SINGLE MODE OF EXPOSURE SUBTOTAL 218,234 (88) MULTIPLE MODES OF EXPOSURE Men who have sex with men; injecting drug use 14,249 (6) Men who have sex with men; hemophilia 58 (0) Men who have sex with men; heterosexual contact 2,872 (1) Men who have sex with men; receipt of transfusion 2,130 (1) Injecting drug use; hemophilia 59 (0) Injecting drug use; heterosexual contact 7,262 (3) Injecting drug use; receipt of transfusion 931 (0) Hemophilia; heterosexual contact 12 (0) Hemophilia; receipt of transfusion 613 (0) Heterosexual contact; receipt of transfusion 609 (0) Men who have sex with men; injecting drug use; hemophilia 17 (0) Men who have sex with men; injecting drug use; heterosexual contact 1,251 (1) Men who have sex with men; injecting drug use; receipt of transfusion 326 (0) Men who have sex with men; hemophilia; heterosexual contact 4 (0) Men who have sex with men; hemophilia; receipt of transfusion 24 (0) Men who have sex with men; heterosexual contact; receipt of transfusion 137 (0) Injecting drug use; hemophilia; heterosexual contact 13 (0) Injecting drug use; hemophilia; receipt of transfusion 23 (0) Injecting drug use; heterosexual contact; receipt of transfusion 299 (0) Hemophilia; heterosexual contact; receipt of transfusion 13 (0) Men who have sex with men; injecting drug use; hemophilia; heterosexual contact 2 (0) Men who have sex with men; injecting drug use; heterosexual contact; receipt of transfusion 5 (0) Injecting drug use; hemophilia; heterosexual contact; receipt of transfusion 49 (0) MULTIPLE MODES of EXPOSURE SUBTOTAL TOTAL * Nineteen adults/adolescents and 2 children developed AIDS after receiving blood screened negative for HIV antibody. Five additional adults developed AIDS after receiving tissue or organs from HIV-infected donors. Two of the 5 received tissue or organs from a donor who was negative for HIV antibody at the time of donation. ** "Other" refers to 7 health-care workers who developed AIDS after occupational exposure to HIV-infected blood, as documented by evidence of seroconversion; and to 2 patients who developed AIDS after exposure to HIV within the health-care setting, as documented by laboratory studies. "Undetermined" refers to patients whose mode of exposure to HIV is unknown. This includes patients under investigation; patients who died, were lost to follow-up, or declined interview; and patients whose mode of exposure to HIV remains undetermined after investigation. TECHNICAL NOTES: HIV/AIDS SURVEILLANCE REPORT Surveillance and Reporting of AIDS All 50 states, the District of Columbia, U.S dependencies and possessions, and independent nations in free association with the U.S. (1) report AIDS cases to CDC using a uniform case definition and case report form. The original definition was modified in 1985 (MMWR 1985;34:373-5) and again in 1987 (MMWR 1987;36 [suppl. no. 1S]:1S-15S). The revisions incorporated a broader range of AIDS indicator diseases and conditions and used human immunodeficiency virus (HIV) diagnostic tests to improve the sensitivity and specificity of the definition. For persons with laboratory- confirmed HIV infection, the 1987 revision incorporated HIV encephalopathy, wasting syndrome, and other indicator diseases that are diagnosed presumptively (i.e., without confirmatory laboratory evidence of the opportunistic disease). AIDS cases that meet the criteria of both the pre- 1987 and 1987 definitions are classified in the pre-1987 definition category. Compared with patients who meet the pre-1987 case definition, a higher proportion of patients who meet only the 1987 case definition were female, black, or Hispanic, or were intravenous drug users (MMWR 1989;38:229- 36). Each issue of this update includes information received and tabulated by CDC through the last day of the previous month. Data are tabulated by date of report to CDC unless otherwise noted. Data for U.S. dependencies and possessions and for associated independent nations are included in the totals. Age group tabulations are based on the person's age at diagnosis of AIDS: adult/adolescent cases include persons 13 years of age and older; pediatric cases include children under 13 years of age. Age group tabulations in Table 13 (only included in the year-end edition) are based on age at death. Metropolitan areas are defined as the Metropolitan Statistical Areas (MSA) for all areas except the 6 New England states. For these states, the New England County Metropolitan Areas (NECMA) are used. Metropolitan areas are named for a central city in the MSA or NECMA, may include several cities and counties, and may cross state boundaries. For example, AIDS cases and annual rates presented for the District of Columbia in Table 1 include only persons residing within the geographic boundaries of the District. AIDS cases and annual rates for Washington, D.C., in Table 2 include persons residing within several counties in the metropolitan area. State or metropolitan data tabulations are based on the person's residence at diagnosis of the first AIDS-indicator disease(s). The cities and counties which comprise each metropolitan area in Table 2 are listed in the Bureau of Census publication, "State and Metropolitan Area Data Book, 1986." Data in this report are provisional. Fifty percent of patients are reported to CDC within 3 months of diagnosis. However, reporting delays vary widely and have been as long as several years for some cases. The median delay in reporting appears to have increased, from about 2 months in 1982 to about 3 months in 1988; however, recent analyses suggests that reporting delay may be decreasing. Completeness of reporting of diagnosed cases to state and local health departments varies by geographic region and patient population; however, mortality studies suggest that 70 to 90 percent of HIV-related deaths in men 25-44 years old are identified through national surveillance of AIDS (MMWR 1989;38:561-3). In addition, multiple routes of exposure, opportunistic diseases diagnosed after the initial case report was submitted to CDC, and vital status may not be determined or reported for all cases. Caution should be used in interpreting case-fatality rates because reporting of deaths is known to be incomplete. Exposure Categories For surveillance purposes, AIDS cases are counted only once in a hierarchy of exposure categories. Persons with more than one reported mode of exposure to HIV are classified in the exposure category listed first in the hierarchy, except for persons with a history of both homosexual/bisexual contact and intravenous drug use. They make up a separate exposure category. "Homosexual/bisexual contact" cases include men who report sexual contact with other men. "Heterosexual contact" cases include persons who report either specific heterosexual contact with a person with, or at increased risk for, HIV infection (e.g., an intravenous drug user), or persons presumed to have acquired HIV infection through heterosexual contact because they were born in countries with a distinctive pattern of transmission termed "Pattern II" by the World Health Organization (MMWR 1988;37:286-8, 293-5). Pattern II transmission is observed in areas of sub-Saharan Africa and in some Caribbean countries. In these countries, most of the reported cases occur in heterosexuals and the male-to-female ratio is approximately 1:1. Intravenous drug use and homosexual transmission either do not occur or occur at a low level. "Undetermined" cases are persons with no reported history of exposure to HIV through any of the routes listed in the hierarchy of exposure categories. Undetermined cases include persons who are currently under investigation by local health department officials; persons whose exposure history is incomplete because of death, refusal to be interviewed, or loss to follow-up; and persons who were interviewed or for whom follow-up information was available and no exposure mode was identified. Persons who have an exposure mode identified at the time of follow-up are reclassified into the appropriate exposure category. Rates Rates are on an annual basis per 100,000 population. The denominator for computing rates in Table 1 and Table 2 are extrapolations based on U.S. Bureau of Census data from the 1980 census and from 1988 post-census estimates. Each 12-month rate is the number of cases for a 12 month period divided by the 1989 or 1990 extrapolation, multiplied by 100,000. The denominators for computing race-specific rates (Table 9, included only in the year-end edition) are based on 1990 census projections published in U.S. Bureau of Census publications, "Projections of the Population of the United States, by Age, Sex, and Race, 1988 to 2080," and "Projections of the Hispanic Population, 1983 to 2080." Race-specific rates are the number of cases reported for a particular race/ethnicity during the preceding 12- month period divided by the 1990 census projection for that race/ethnicity, multiplied by 100,000. Case-fatality rates are on a semiannual basis by date of diagnosis. Each 6- month case-fatality rate is the number of fatal cases reported, divided by the number of total cases, diagnosed in that period, multiplied by 100. Trends in AIDS Incidence Tabulations of AIDS cases by date of report give a general description of AIDS cases, but analyses by date of diagnosis give a more accurate description of trends. Delays in reporting, however, can have a substantial impact on tabulated numbers of cases diagnosed in recent time periods. About half of all cases are reported within 3 months of diagnosis, but about 15% are reported more than 1 year after diagnosis. Delays are substantially longer for pediatric cases and for transfusion-associated cases in adults. Figure 5 (included only in the year-end edition report) shows trends in AIDS incidence by month of diagnosis. The points on the plot show the estimated numbers of cases diagnosed, after adjusting for estimated reporting delays. The smooth curve is computed using the Lowess procedure (J.M. Chaber, W.S. Cleveland, B. Kleiner, and P.A. Tukey. "Graphical Methods for Data Analysis." Duxbury Press, Boston, 1983, Chapter 4). Reporting delays were estimated by a maximum likelihood statistical procedure for each HIV exposure category (J.M. Karon, O.J. Devine, and W.M. Morgan "Predicting AIDS incidence by extrapolating from recent trends." In: C. Castillo-Chavex, ed. "Mathematical and Statistical Approaches to AIDS Epidemiology. Lecture Notes in Biomathematics," vol. 83, Springer Verlag, Berlin, 1989). The adjusted incidence used in Figure 5 is the sum of the adjusted incidences for each HIV exposure group. The Lowess procedure makes no assumption about the overall trends in the data. A fitted value is computed for each month by weighted least squares regression using only the adjusted number of cases diagnosed during an interval about the month (in Figure 5, the 30% of months closest to the chosen month); the weights decrease for times further from the chosen month. The procedure assumes that incidence during the interval about each month is approximately a linear function of time. Lowess tends to produce a curve that is linear at each end, as observed in the figure; predictions of future numbers of cases should not be made by extrapolating the Lowest curve. The Lowess curve should be considered a description of the overall trend in AIDS cases. This curve emphasizes that the rate of increase in incidence slowed during the middle of 1987. See MMWR 1990:39:81-86. (1) Included among the dependencies, possessions, and independent nations are Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the Republic of Palau, the Republic of the Marshall Islands, the Commonwealth of the Northern Mariana Islands, and the Federated States of Micronesia. The latter 5 comprise the category "Pacific Islands, U.S." listed in Table 1. --- Internet: david@stat.com FAX: +1 (602) 451-1165 Bitnet: ATW1H@ASUACAD FidoNet=> 1:114/15 Amateur Packet ax25: wb7tpy@wb7tpy.az.usa.na