Reports on HIV/AIDS: 1990

FEBRUARY 9, 1990, MMWR, Vol. 39, No. 5, pp. 81-86
The number of AIDS cases in 1989 can be compared with those in 1988 in two
ways: 1) by using cases reported during these two periods, although these cases may
have been diagnosed in earlier periods, and 2) by using cases diagnosed in these two
periods and adjusting for reporting delays (1). These two comparisons yield different
results for some categories of AIDS cases primarily because of changes in surveillance criteria, which were implemented in late 1987 (2).
Surveillance based on date of report. Compared with the 32,196 cases reported in
1988, AIDS cases reported in 1989 increased 9%. Large proportional increases
occurred for cases reported in the South, in metropolitan areas with populations
<500,000, and for persons exposed to human immunodeficiency virus (HIV) through
heterosexual contact or perinatal transmission (Table 1). The largest proportional
declines occurred among children infected with HIV through receipt of transfusions or
clotting factors; smaller proportional declines occurred for adults who had received
transfusions (Table 1).
Surveillance based on date of diagnosis. When 1989 and 1988 were compared
based on cases diagnosed in comparable 1-year periods (October 1-September 30
[adjustments for reporting delays cannot be done reliably for the most recent
quarter]), cases increased 14%. Other differences were: proportional increases
among both blacks and Hispanics exceeded the increase for whites; cases increased
in the Northeast, although proportionately less than elsewhere; the percentage
increase for women was substantially greater than that for men; the percentage
increase for heterosexual IVDUs exceeded that for homosexual/bisexual men; and
cases due to perinatal HIV transmission had the largest increase among HIV exposure
groups (Table 1).
Long-term trends. In mid-1987, trends in AIDS cases by date of diagnosis (adjusted
for reporting delays) shifted-primarily reflecting a shift in trends for homosexual/
bisexual men (Figure 2a). Cases among adult transfusion recipients and persons with
hemophilia did not increase as rapidly as in earlier years and may have reached or
neared their peaks (Figure 2b). Cases associated with heterosexual IV-drug use
(Figure 2a), heterosexual contact (Figure 2c), and perinatal transmission (Figure 2d)
continued to increase.
Reported by: Local, state, and territorial health departments. Div of HIV/AIDS, Center for
Infectious Diseases, CDC.
Editorial Note: Analysis of surveillance data for AIDS cases elucidates trends in the
characteristics of persons with severe HIV disease. Varying trends for different
categories of AIDS patients in 1989 highlight the increasing complexity and extent of
the HIV/AIDS epidemic.
Interpretation of these trends is complex because of the expansion of AIDS
surveillance criteria in late 1987 (2), which extended the usefulness of surveillance in
describing severe HIV disease. The new criteria led to greater increases in reporting
for cases in IVDUs, blacks and Hispanics, and persons living in the Northeast (4 ) than
for AIDS cases in other persons. Also, some areas retrospectively reported cases that
met the new criteria but were diagnosed before the new criteria were implemented
(2289 such cases were reported in 1988 and 623 in 1989). There are also other
temporal and geographic variations in reporting delays; thus, comparisons between
1988 and 1989 differ depending on whether date of diagnosis or date of report is used.
Cases diagnosed among homosexual/bisexual men continued to increase but not
as rapidly as in previous years; this change is most apparent in cities such as New

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