Reports on HIV/AIDS: 1990

NOVEMBER 30, 1990, MMWR, Vol. 39, RR-16 [inclusive page numbers]
non-AIDS members of the Multicenter AIDS Cohort Study (MACS) were taking any
drug for AIDS therapy or prophylaxis in 1987, although this figure may be modified or
augmented on the basis of ongoing data analysis.
National reporting in 1987 was similar to or more complete than that in previous
years, so underreporting was not thought to be a major contributor to the downturn
in reported AIDS cases. However, increasingly more homosexual men and others
with AIDS have been receiving ambulatory, out-of-hospital diagnosis and treatment.
This trend may be causing some decrease in the completeness and/or timeliness of
AIDS case reporting in some areas.
The observed change in trend in reported cases of AIDS may represent, at least in
part, a true diminution in HIV infection among homosexual and bisexual men The
number of reported AIDS cases has begun to level off and/or decline among adult and
pediatric transfusion recipients and persons with hemophilia, for whom HIV incidence
drastically declined in the mid-1980s. The group thought that models assuming
substantial infection rates after 1982 or 1983 might be inaccurate given the sharp drop
in new infections among homosexual men among recruited cohorts in the 1980s, the
>50% decrease in rectal gonorrhea cases among men in several U.S. cities between
1982 and 1984, and various calculations that show a peaking of HIV infections among
homosexual men as early as 1981. Despite the long incubation period from acquisition of HIV infection to development of symptoms of AIDS, one might still have
expected to see some leveling in AIDS case trends among homosexual and bisexual
men in San Francisco, Los Angeles, and New York by 1987. More conservative
assumptions in back-calculation models may be useful to assess the robustness of
any putative impact of treatment as well as other factors.
Future research needs to address several issues. Whether zidovudine, dideoxyinosine (ddl), and other new drugs might diminish the infectiousness of HIVseropositive persons for their sex partners is unknown. If such drugs do reduce
infectiousness, effective therapy could contribute to an eventual decrease in reported
AIDS cases. Conversely, considerable data indicate that therapy (including that for
drug addiction) can substantially increase survival. Unless therapy reduces infectiousness, a larger pool of living patients with AIDS and other persons infected with
HIV will increase the number of infectious persons and, without changes in behavior,
could ultimately increase AIDS cases. Researchers need to use behavioral studies and
models to address this possibility.
Recommendations
1. Data from on going studies on treatment effects should be released as soon as
possible to allow the most current data to be incorporated into models of the
epidemic.
2. Existing data regarding prevalence of use of HIV/AIDS therapeutic agents
should be analyzed promptly.
Actions taken since meeting
1. Data from current cohort studies have been used to estimate the use of therapy
by homosexual men at different stages of HIV infection (28,29). This fulfills
recommendation 2.
2. Data from current studies funded by CDC, National Institutes of Health (NIH),

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