Skip to main content

Advertisement

SpringerLink
Log in

The changing epidemic of HIV

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Now in its third decade, the epidemiology of human immunodeficiency virus (HIV) transmission in the United States has changed considerably since the epidemic began. Our increased understanding of the virus has fueled development of new treatments to prolong life, and research into a viable vaccine offers hope to those at risk in developed and less developed countries alike. In this review, we provide information about the current trends in HIV and Acquired Immune Deficiency Syndrome (AIDS) among those in the United States who are hardest hit by the epidemic. We also offer insights into and explanations of these changes; update the epidemiology of HIV subtypes and antiretroviral resistance; and describe current strategies for HIV surveillance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. UNAIDS/WHO Global AIDS Statistics: AIDS Care 1999, 11(2):253–264.

    Google Scholar 

  2. Centers for Disease Control and Prevention: US HIV and AIDS cases reported through December 1999. HIV/AIDS Surveillance Report 1999, 11(2):1–42.

    Google Scholar 

  3. Rosenberg P: Scope of the AIDS epidemic in the United States. Science 1995, 270:1372–1375.

    Article  PubMed  CAS  Google Scholar 

  4. Karon JM, Fleming PL, Steketee RW, DeCock KM: HIV in the United States in the late 1990’s: an epidemic in transition. Am J Public Health, 2000 [submitted].

  5. Karon J, Rosenberg P, McQuillan G, et al.: Prevalence of HIV infection in the United States, 1984 to 1992. JAMA 1996, 276:126–131.

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control and Prevention. Guidelines for national human immunodeficiency virus case surveillance, including monitoring of human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR Morb Mort Wkly Rep. 1999, 48(RR-13):1–31. This CDC report provides the rationale for recommending combined HIV/AIDS surveillance, and offers guidance to state and local health departments that have recently expanded or soon expect to expand their AIDS surveillance systems to include reporting of HIV cases. The report also includes a revised case definition of HIV infection in adults and children, effective January 2000.

    Google Scholar 

  7. Ward JW, Duchin JS: The epidemiology of HIV and AIDS in the United States. AIDS Clin Rev 1997, 1–45.

  8. Wortley P, Fleming P: AIDS in women in the United States. Recent trends. JAMA 1997, 278:911–916. This seminal paper describes trends in AIDS incidence in women through June 1996, and documents increases in the number of cases of heterosexually acquired HIV in younger women.

    Article  PubMed  CAS  Google Scholar 

  9. Rosenberg P, Biggar R: Trends in HIV incidence among young adults in the United States. JAMA 1998, 279:1894–1899. This paper describes trends in HIV incidence in young persons (based on back-calculation from AIDS cases), between 1988 and 1993. During that time, HIV prevalence in white men decreased by 50%, while staying relatively stable in black and Hispanic men. Conversely, HIV prevalence in women rose, due primarily to heterosexual transmission.

    Article  PubMed  CAS  Google Scholar 

  10. Johnson E, Jackson L, Hinkle Y, et al.: What is the significance of black-white differences in risky sexual behavior? J Natl Med Assoc. 1994, 86:745–759.

    PubMed  CAS  Google Scholar 

  11. Laumann EO, Youm Y: Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis 1998, 26:250–261.

    Google Scholar 

  12. Wasserheit JN, Aral SO: The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies. J Infect Dis 1996, 174:S201-S213.

    PubMed  Google Scholar 

  13. Dolcini M, Coates T, Catania J, et al.: Multiple sexual partners and their psychosocial correlates: the population-based AIDS in multiethnic neighborhoods (AMEN) study. Health Psychol 1995, 14:22–31.

    Article  PubMed  CAS  Google Scholar 

  14. Peterson J, Grinstead O, Golden E, et al.: Correlates of HIV risk behaviors in black and white San Francisco heterosexuals: the population-based AIDS in multiethnic neighborhoods (AMEN) study. Ethn Dis 1992, 2:361–370.

    PubMed  CAS  Google Scholar 

  15. Grinstead O, Peterson J, Faigeles B, Catania J: Antibody testing and condom use among heterosexual African Americans at risk for HIV infection: the National AIDS Behavioral Surveys. Am J Public Health 1997, 87:857–859.

    PubMed  CAS  Google Scholar 

  16. Fleming P, Ward J, Karon J, et al.: Declines in AIDS incidence and deaths in the USA: a signal change in the epidemic. AIDS 1998, 12(Suppl A):S55-S61. This paper documents trends in decreasing AIDS incidence and deaths from AIDS, from 1987 through 1996, in the United States. In light of theses declines, the authors describe a reassessment of the structure and goals of public health surveillance and of prevention and care programs.

    PubMed  Google Scholar 

  17. Fischl M, Richman D, Grieco M, et al.: The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med 1987, 317:185–191.

    Article  PubMed  CAS  Google Scholar 

  18. Kitchen V, Skinner C, Ariyoshi K, et al.: Safety and activity of saquinavir in HIV infection. Lancet 1995, 345:952–955.

    Article  PubMed  CAS  Google Scholar 

  19. Centers for Disease Control and Prevention: Recommendations of the US Public Health Service Task Force on the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus. MMWR Morb Mort Wkly Rep 1994, 43(RR-11):1–20.

    Google Scholar 

  20. Carr A, Samaras K, Chisholm DJ, Cooper DA: Pathogenesis of HIV1 protease inhibitor associated peripheral lipodystrophy, hyperlipidemia, and insulin resistance. Lancet 1998, 351:1881–1883.

    Article  PubMed  CAS  Google Scholar 

  21. Tebas P, Powderly WG, Claxton S, et al.: accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy [abstract]. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:207.

  22. Hoy J, Hudson J, Law M, Cooper DA: Osteopenia in a randomized, multicenter study of protease inhibitor (PI) substitution in patients with the lipodystrophy syndrome and well-controlled HIV viremia [abstract]. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:208.

  23. Sulkowski M, Thomas D, Chaisson R, Moore R: Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 2000, 283:74–80.

    Article  PubMed  CAS  Google Scholar 

  24. Sullivan P, Chu S, Fleming P, Ward J: Changes in AIDS incidence for men who have sex with men, United States 1990–1995. AIDS 1997, 11:1641–1646.

    Article  PubMed  CAS  Google Scholar 

  25. Denning PH, Jones JL, Ward J: Recent trends in the HIV epidemic in adolescent and young adult gay and bisexual men. J Acquir Immune Defic Syndr Hum Retrovirol 1997, 16:374–379.

    PubMed  CAS  Google Scholar 

  26. Katz M, McFarland W, Guillin V, et al.: Continuing high prevalence of HIV and risk behaviors among young men who have sex with men: the young men’s survey in the San Francisco Bay Area in 1992 to 1993 and in 1994 to 1995. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 19:178–181.

    PubMed  CAS  Google Scholar 

  27. McFarland W, Kellogg TA, Dilley J, Katz MH: Estimation of human immunodeficiency virus (HIV) seroincidence among repeat anonymous testers in San Francisco. Am J Epidemiol 1997, 146:662–664.

    PubMed  CAS  Google Scholar 

  28. Kellogg T, McFarland W, Katz M: Recent increases in HIV seroconversion among repeat anonymous testers in San Francisco [letter]. AIDS 1999, 13:2303–2304.

    Article  PubMed  CAS  Google Scholar 

  29. Centers for Disease Control and Prevention: HIV/AIDS among men of color who have sex with men-United States, January 1989-December 1998. MMWR Morb Mort Wkly Rep 2000, 49:4–11.

    Google Scholar 

  30. Ekstrand M, Stall R, Paul J, et al.: Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS 1999, 13:1525–1533. This paper is one of the first to document a return to high risk behaviors in some high-risk groups. The authors postulate that current AIDS prevention efforts may not be offering effective prevention messages to new generations of gay or bisexual men or to those categorized as “high transmission risks.”

    Article  PubMed  CAS  Google Scholar 

  31. Denning PH: Is the stage being set for a resurgence in the HIV epidemic among men who have sex with men? [abstract]. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:S30.

  32. Centers for Disease Control and Prevention: Resurgent bacterial sexually transmitted disease among men who have sex with men, King County, Washington, 1997–1999. MMWR Morb Mort Wkly Rep. 1999, 48:773–777.

    Google Scholar 

  33. Centers for Disease Control and Prevention: Increases in unsafe sex and rectal gonorrhea among men who have sex with men, San Francisco, California, 1994–1997. MMWR Morb Mort Wkly Rep. 1999, 48:45–48.

    Google Scholar 

  34. Do A, Hanson D, Dworkin M, Jones J: risk factors and trends of gonorrhea incidence among HIV-infected patients, United States [abstract]. In Proceedings of the Conference of the Infectious Disease Society of America. San Francisco, 1998.

  35. Centers for Disease Control and Prevention: HIV prevention through early detection and treatment of sexually transmitted diseases — United States. MMWR Morb Mort Wkly Rep 1998, 47(RR-12):1–31.

    Google Scholar 

  36. Dilley J, Woods W, McFarland W: Are advances in treatment changing views about high-risk sex? [letter]. N Engl J Med 1997, 337:501–502.

    Article  PubMed  CAS  Google Scholar 

  37. Lehman JS, Hecht F, Wortley P, et al.: Are At-risk populations less concerned about HIV infection in the HAART era? [abstract]. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:198.

  38. Des Jarlais D, Friedman SR: Fifteen years of research on preventing HIV infection among injecting drug users: what we have learned, what we have not learned, what we have done, what we have not done. Public Health Rep 1998, 113(Suppl 1):182–188.

    PubMed  Google Scholar 

  39. Des Jarlais D, Hagan H, Friedman SR,: Maintaining low HIV seroprevalence in populations of injecting drug users. JAMA 1995, 274:1226–1231.

    Article  PubMed  Google Scholar 

  40. Des Jarlais D, Friedman SR, Perlis T, et al.: Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. J Acquir Immune Defic Syndr Hum Retrovirol 1999, 20:67–72.

    PubMed  Google Scholar 

  41. Coates T, Aggleton P, Gutzwiller F, et al.: HIV prevention in developed countries. Lancet 1996, 348:1143–1148.

    Article  PubMed  CAS  Google Scholar 

  42. Des Jarlais D, Friedman SR, Sotheran JL, et al.: Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992. JAMA 1994, 271:121–127.

    Article  PubMed  Google Scholar 

  43. Centers for Disease Control and Prevention (CDC). National HIV Prevalence Surveys, 1997 Summary. Atlanta: Division of HIV/ AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, CDC; 1998:1–25.

    Google Scholar 

  44. Des Jarlais D, Marmor M, Friedmann P, et al.: HIV incidence among injection drug users in New York City, 1992–1997: evidence for a declining epidemic. Am J Public Health 2000, 90:352–359. This compendium of 10 studies documents a large decrease in HIV incidence among New York City injection drug users (weighted average: less than 1 per 100 person years). The authors note that, while HIV infections continue to occur in this cohort, they do so at much lower levels than previously observed. It is not possible to determine the cause(s) of this new low incidence, but low incidence among IDUs in the United States appears to be a pattern in existing cohort studies.

    PubMed  Google Scholar 

  45. Holmberg S: The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health 1996, 86:642–654.

    PubMed  CAS  Google Scholar 

  46. Community Epidemiology Work Group (CEWG), National Institutes of Health, National Institute on Drug Abuse: Drug abuse highlights for the United States. Presented at the Meeting of the CEWG. Miami, FL, 1998; Epidemiologic Trends in Drug Abuse Advance Report, December, 1998, availavle on-line at:

  47. Neal J, Fleming P, Green T, Ward J: Trends in heterosexually acquired AIDS in the United States, 1988 through 1995. J Acquir Immune Defic Syndr Hum Retrovirol 1997, 14:465–474.

    PubMed  CAS  Google Scholar 

  48. Klevens R, Fleming P, Neal J, Li J: Is there really a heterosexual AIDS epidemic in the United States? Findings from a multisite validation study, 1992–1995. Mode of Transmission Validation Study Group. Am J Epidemiol 1999, 149:75–84.

    PubMed  CAS  Google Scholar 

  49. Mastro T, Satten G, Nopkesorn T, et al.: Probability of female-to-male transmission of HIV-1 in Thailand. Lancet 1994, 343:204–207.

    Article  PubMed  CAS  Google Scholar 

  50. Edlin B, Irwin K, Faruque S, et al.: Intersecting epidemics-crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med 1994, 331:1422–1427.

    Article  PubMed  CAS  Google Scholar 

  51. European Study Group on Heterosexual Transmission of HIV: Comparison of female to male and male to female transmission in 563 stable couples. BMJ 1992, 304:809–813.

    Google Scholar 

  52. Buve A: HIV/AIDS in Africa: Why so severe, why so heterogenous? In Presented at the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000.

  53. Grosskurth H, Mosha F, Todd J, et al.: Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial. Lancet 1995, 346:530–536.

    Article  PubMed  CAS  Google Scholar 

  54. Wawer MJ, Sewankambo NK, Serwadda D, et al.: Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomized community trial. Rakai Project Study Group. Lancet 1999, 353:525–535.

    Article  PubMed  CAS  Google Scholar 

  55. Fleming D, Wasserheit J: From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999, 75:3–17.

    PubMed  CAS  Google Scholar 

  56. Wasserheit J. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992, 19:61–77.

    PubMed  CAS  Google Scholar 

  57. Centers for Disease Control and Prevention: HIV prevention through early detection and treatment of other sexually transmitted diseases—United States. Recommendations of the Advisory Committee for HIV and STD prevention. MMWR Morb Mortal Wkly Rep 1998, 47:1–24.

    Google Scholar 

  58. Kamb M, Irwin K, Cohen D, et al.: Assessing feasibility of STD control interventions for HIV prevention in the United States. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:467.

  59. Guinan M, Leviton L: Prevention of HIV infection in women: overcoming barriers. J Am Med Wom Assoc 1995, 50:74–77.

    PubMed  CAS  Google Scholar 

  60. Lindegren M, Steinberg S, Byers R: Epidemiology of HIV/AIDS in children. Pediart Clin North Am 2000, 47:1–20.

    Article  CAS  Google Scholar 

  61. Lindegren M, Byers R Jr, Thomas P, et al.: Trends in perinatal transmission of HIV/AIDS in the United States. JAMA 1999, 282:531–538. This paper describes trends in incidence of perinatal AIDS through June 1998, and factors contributing to these trends. Overall, perinatal AIDS cases decreased 67% from 1992 through 1997, largely due to decreases in perinatal HIV transmission following treatment with zidovudine.

    Article  PubMed  CAS  Google Scholar 

  62. Simonds R, Steketee R, Nesheim S, et al.: Impact of zidovudine use on risk and risk factors for perinatal transmission of HIV. Perinatal AIDS Collaborative Transmission Studies. AIDS 1998, 12:301–308.

    Article  PubMed  CAS  Google Scholar 

  63. Stek A, Kramer F, Fassett M, et al.: The safety and efficacy of protease inhibitor therapy for HIV infection during pregnancy [abstract]. Am J Obstet Gynecol 1999, 180(Suppl):7.

    Google Scholar 

  64. The International Perinatal HIV Group: The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1. N Engl J Med. 1999, 340:977–987. The results of this meta-analysis suggest that elective cesarean section reduces the risk of mother-to-child HIV transmission by 50%, independent of the effects of treatment with zidovudine.

    Article  Google Scholar 

  65. Gortmaker S, Hughes M, Oyomopito R, et al.: Impact of introduction of protease inhibitor therapy on reductions in mortality among children and youth infected with HIV-1 [abstract]. In Proceedings of the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000:691.

  66. Guay L, Musoke P, Fleming T, et al.: A randomized trial of single-dose nevirapine to mother and infant vs. azidothymidine in Kampala, Uganda for prevention of Mother-to-infant transmission of HIV-1 (HIVNET 012). In Presented at the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000.

  67. Cardo DM, Culver DH, Ciesielski CA, et al.: A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997, 337:1485–1490.

    Article  PubMed  CAS  Google Scholar 

  68. Centers for Disease Control and Prevention: Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep 1998, 47(RR-7):1–33.

    Google Scholar 

  69. Bell DM: Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med. 1997, 102:9–15.

    Article  PubMed  CAS  Google Scholar 

  70. Jochimson EM, Luo CC, Beltrami JF, et al.: Investigations of possible failures of postexposure prophylaxis following occupational exposures to human immunodeficiency virus. Arch Intern Med 1999, 159:2361–2363.

    Article  Google Scholar 

  71. Dean-Gaitor H, Fleming P: Epidemiology of AIDS in incarcerated persons in the United States, 1994–1996. AIDS 1999, 13:2429–2435.

    Article  PubMed  CAS  Google Scholar 

  72. Adimora AA, Schoenback VJ, Stancil TR, et al.: Incarceration and heterosexual HIV infection among rural African Americans. In Presented at the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000.

  73. Conklin TJ, Lincoln T, Flanigan TP: A public health model to connect correctional health care with communities. Am J Public Health 1998, 88:1249–1250.

    PubMed  CAS  Google Scholar 

  74. Flanigan TP, Kim J, Zierler S, et al.: A prison release program for HIV-positive women: linking them to health services and community follow up. Am J Public Health 1996, 86:886–887.

    PubMed  CAS  Google Scholar 

  75. Simonds R, Holmberg S, Hurwitz R, et al.: Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 1992, 326:726–732.

    Article  PubMed  CAS  Google Scholar 

  76. Lackritz E, Satten G, Aberle-Grasse J, et al.: Estimated risk of transmission of the human immunodeficiency virus by screened blood in the United States. N Engl J Med 1995, 333:1721–1725.

    Article  PubMed  CAS  Google Scholar 

  77. Busch M: Application of high throughput, qualitative nucleic acid tests for HIV/HCV in blood donor screening, diagnostic, and public health settings. In Presented at the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000.

  78. Surgenor DM, Wallace EL, Hao SHS, Chapman T: Collection and transfusion of blood in the United States, 1982–1988. N Engl J Med 1990, 322:1646–1651.

    Article  PubMed  CAS  Google Scholar 

  79. Centers for Disease Control and Prevention: U.S. Public Health Service guidelines for testing and counseling blood and plasma donors for human immunodeficiency virus type 1 antigen. MMWR Morb Mortal Wkly Rep 1996, 45:1–9.

    Google Scholar 

  80. Lackritz E, Stramer SL, Jacobs TA, et al.: Results of national testing of U.S. blood donations for HIV-1 p-24 antigen. In Presented at the Conference on Retroviruses and Opportunistic Infections. Washington DC, 1997.

  81. Busch MP, Kleinman SH, Jackson B, et al.: Committee report. Nucleic acid amplification testing of blood donors for transfusion-transmitted infectious diseases: Report of the Interorganizational Task Force on Nucleic Acid Amplification Testing of Blood Donors. Transfusion 2000. 40:143–159.

    Article  PubMed  CAS  Google Scholar 

  82. Pretty IA, Anderson GS, Sweet DJ: Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol 1999, 20:232–239.

    Article  PubMed  CAS  Google Scholar 

  83. Mast EE, Goodman RA, Bond WW, et al.: Transmission of bloodborne pathogens during sports: risk and prevention. Ann Intern Med 1995, 122:28–35.

    Google Scholar 

  84. Lindegren M, Hanson I, Hammett T, et al.: Sexual abuse of children: intersection with the HIV epidemic. Pediatrics 1998, 102:E46.

    Article  PubMed  CAS  Google Scholar 

  85. Kennedy M, Scarlett M, Duerr A, Chu S: Assessing HIV risk among women who have sex with women: scientific and communication issues. J Am Med Wom Assoc 1995, 50:103–107.

    PubMed  CAS  Google Scholar 

  86. Sullivan P, Do A, Robbins K, et al.: Surveillance for variant strains of HIV: subtype G and group O HIV-1 [letter]. JAMA 1997, 278:292.

    Article  PubMed  CAS  Google Scholar 

  87. Sullivan P, Do A, Ellenberger D, et al.: Human immunodeficiency virus (HIV) subtype surveillance of African-born persons at risk for group O and group N HIV infections in the United States. J Infect Dis 2000, 181:463–469.

    Article  PubMed  CAS  Google Scholar 

  88. Schable C, Zekeng L, Pau CP, et al.: Sensitivity of United States HIV antibody tests for detection of HIV-1 group O infections. Lancet 1994, 344:1333–1334.

    Article  PubMed  CAS  Google Scholar 

  89. Weidle P, Ganea C, Irwin K, et al.: Presence of human immunodeficiency virus (HIV) type 1, group M, nn-B subtypes, Bronx, New York: a sentinel site for monitoring HIV genetic diversity in the United States. J Infect Dis 2000, 181:470–475.

    Article  PubMed  CAS  Google Scholar 

  90. Irwin K, Pau C, Lupo D, et al.: Presence of human immunodeficiency virus (HIV) type 1 subtype A infection in a New York community with high HIV prevalence: a sentinel site for monitoring HIV genetic diversity in North America. Centers for Disease Control and Prevention-Bronx Lebanon HIV Serosurvey Team. J Infect Dis 1997, 176:1629–1633.

    Article  PubMed  CAS  Google Scholar 

  91. Palella F Jr, Delaney K, Moorman A, et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998, 338:853–860. This paper was one of the first to show that the recent declines in morbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies.

    Article  PubMed  Google Scholar 

  92. Cohen C, Hunt S, Sension M, et al.: Phenotypic resistance testing significantly improves response to therapy: A randomized trial (VIRA3001). In Presented at the Conference on Retroviruses and Opportunistic Infections. San Francisco, 2000.

  93. Little S, Daar E, D’Aquila R, et al.: Reduced antiretroviral drug susceptibility among patients with primary HIV infection. JAMA 1999, 282:1142–1149. This paper documents a high prevalence of reductions in susceptibility, from 2.5-fold to 10-fold, to certain antiretroviral drugs among newly infected, drug-naive patients. The authors suggest that resistance testing may be warranted, to monitor the frequency of drug resistance over time and to assess the potential for geographic variability.

    Article  PubMed  CAS  Google Scholar 

  94. Wang C, Looney D, Li M, et al.: Long-term high-titer neutralizing activity induced by octameric synthetic HIV-1 antigen. Science 1991, 254:285–288.

    Article  PubMed  CAS  Google Scholar 

  95. Cohen J: A new goal: preventing disease, not infection. Science 1993, 262:1820–1820.

    Article  PubMed  CAS  Google Scholar 

  96. Frey S: HIV vaccines. Infect Dis Clin North Am 1999, 13:95–112.

    Article  PubMed  CAS  Google Scholar 

  97. Anderson RM, Swinton J, Garnett GP: Potential impact of low efficacy HIV-1 vaccines in populations with high rates of infection. Proc R Soc Lond B Biol Sci 1995, 261:147–151.

    Article  CAS  Google Scholar 

  98. Centers for Disease Control and Prevention: Update: trends in AIDS incidence—United States, 1996. MMWR Morb Mort Wkly Rep 1997, 46:861–867.

    Google Scholar 

  99. Forbes A: Naming names — mandatory name-based reporting: impact and alternatives. AIDS Policy Law 1996, 1–4.

  100. Nakashima A, Horsley R, Frey R, et al.: Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs. JAMA 1998, 280:1421–1426. This paper reports that policies of confidential HIV reporting by name did not appear to affect the use of HIV testing in publicly funded counseling and testing programs in six states.

    Article  PubMed  CAS  Google Scholar 

  101. Centers for Disease Control and Prevention: HIV testing among populations at risk for HIV infection—nine states, November 1995—December 1996. MMWR Morb Mort Wkly Rep 1998, 47:1086–1091.

    Google Scholar 

  102. Hecht FM, Coleman S, Lehman JS, et al.: Named HIV reporting: does HIV reporting by name deter testing? AIDS [in pre .

Download references

Author information

Authors and Affiliations

  1. Surveillance Branch, Division of HIV/AIDS Prevention - Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop E-47, 30333, Atlanta, GA, USA

    Scott Kellerman MD, MPH, Pascale Wortley MD, MPH & Patricia Fleming PhD, MS

Authors
  1. Scott Kellerman MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pascale Wortley MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia Fleming PhD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kellerman, S., Wortley, P. & Fleming, P. The changing epidemic of HIV. Curr Infect Dis Rep 2, 457–465 (2000). https://doi.org/10.1007/s11908-000-0076-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-000-0076-y

Keywords

Search

Navigation