dmcanzi@watserv1.waterloo.edu (David Canzi) (03/03/90)
Medical News for the Past Two Weeks, Ending February 25, 1990
Copyright 1990: USA TODAY/Gannett National Information Network
Reproduced with Permission
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Feb. 2-4, 1990
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SYPHILIS CASES UP IN 1989:
The upward turn in syphilis cases continued in 1989 to a 41-year peak,
alarming health officials who say the trend indicates non-use of condoms which
could also prevent AIDS. There were about 44,000 cases in 1989, compared to
39,200 in 1988 and 33,800 in 1987. The disease is passed through sex or birth,
and can be deadly if untreated. (From the USA TODAY Life section.)
NEW HIV INFECTIONS DROPPING:
The number of new annual human immunodeficiency virus infections - which
leads to AIDS - peaked in 1986 and is declining, reports the current issue of
Contingencies, an actuary journal. But it has projected that the number of new
AIDS cases will continue to rise until 1995, before it starts declining.
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Feb. 5, 1990
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NEW REPEL GLOVE PREVENTS CUTS:
Du Pont has introduced Repel Glove Liners, made of Kevlar fiber, to help
surgeons and other health care professionals prevent cuts that can become
routes for transmission of diseases like AIDS. A surgeon wears the liner
beneath latex gloves to ward off slashes; the product is made of the same
fibers used in bullet-proof vests and military helmets.
HIV TEST, SUICIDES UNLINKED:
Thoughts of suicide do not increase immediately after a positive HIV test,
reports the Journal of the American Medical Association's Feb. 2 issue. In the
week after test results, self-reported suicidal thoughts dropped among those
who tested negative and did not rise among those testing positive.
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Feb. 8, 1990
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BRITAIN SENDS ROMANIA SYRINGES:
Britain will send one million disposable syringes to Romania, responding to
reports of the world's first epidemic of childhood AIDS there. The World
Health Organization said medical teams have found 700 Romanian children
affected with the AIDS virus. The organism is spreading via contaminated blood
transfusions and the reuse of needles. (From the USA TODAY News section.)
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Feb. 9-11, 1990
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AIDS VIRUS-INFECTED CAN WORK:
AIDS virus infection shouldn't automatically disqualify carriers from
working, suggests a study reported in Thursday's Neurological Journal. There
have been fears that HIV carriers may suffer brain damage without other
symptoms; the study says neurological damage linked to the virus rarely occurs
before other serious symptoms. (From the USA TODAY Life section.)
AIDS CASES UP 9 PERCENT IN '89:
The number of AIDS cases rose 9 percent over the past year, from 32,196 in
1988 to 35,238 in 1989, the Centers for Disease Control reported Thursday.
While cases rose more quickly among heterosexuals, gay or bisexual men still
accounted for 56 percent of new cases. Intravenous drug users accounted for 23
percent.
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Feb. 12, 1990
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BLACK CRACK USERS AT AIDS RISK:
Although they are afraid of getting AIDS, many black teen crack users often
trade sex for the drug, putting themselves at high risk for sexually
transmitted diseases, reports a study in the Feb. 9 Journal of the American
Medical Association. Of 222 surveyed, 76 percent had AIDS fears but 73 percent
followed unsafe sex practices like failure to use condoms or exchanging money
for drugs or money.
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Center for Disease Control Reports
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Morbidity and Mortality Weekly Report
Thursday February 8, 1990
Current Trends
Update: Acquired Immunodeficiency Syndrome -- United States, 1989
During 1989, state and territorial health departments reported 35,238
cases (14.0 per 100,000 population) of acquired immunodeficiency syndrome
(AIDS) to CDC. Rates (reported cases per 100,000 population) were highest for
blacks and Hispanics; for persons 30-39 years of age; in the Northeast region
and in U.S. territories (primarily reflecting rates in Puerto Rico); in the
largest metropolitan areas; and for men (Table 1). Rates varied widely among
states (Figure 1).* As in previous years, most reported cases occurred among
men who had had sex with other men (homosexual/bisexual men) (56%) and among
heterosexual intravenous-drug users (IVDUs) (23%).
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 less than 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 York, San Francisco, and Los Angeles (5). Possible reasons for
this observation include actual declines in the incidence of HIV infection,
perhaps due to the success of prevention programs; the effect of treatments
that delay progression of HIV disease; and a decrease in the completeness of
reporting (5,6).
Since routine screening of donated blood for HIV antibody began in 1985,
transmission of HIV through blood transfusions has become rare (7).
Transfusion-associated AIDS now occurs predominantly among persons who
received transfusions before screening began. Occurrence of such cases has
leveled or possibly begun to decline, demonstrating the effectiveness of
screening.
Increases in diagnosed cases were greatest for groups with little or no
evidence of reductions in HIV incidence, such as IVDUs and associated groups
(i.e., persons infected with HIV by heterosexual contact and perinatal
transmission). Even though AIDS cases are heavily concentrated in the largest
cities, the epidemic is increasingly affecting smaller communities.
References
1. Karon JM, Devine OJ, Morgan WM. Predicting AIDS incidence by extrapolating
from recent trends. In: Castielo-Chavez C, ed. Mathematical and statistical
approaches to AIDS epi demiology: lecture notes in biomathematics. Vol 83.
Berlin: Springer-Verlag, 1989.
2. CDC. Revision of the CDC surveillance case definition for acquired
immunodeficiency syn drome. MMWR 1987;36(no. 1S).
3. Chambers JM, Cleveland WS, Kleiner B, Tukey PA. Graphical methods for data
analysis. Belmont, California: Wadsworth International Group, 1983:91-104,121-
3.
4. Selik RM, Buehler JW, Karon JM, et al. Impact of the 1987 revision of the
case definition of acquired immune deficiency syndrome in the United States. J
AIDS 1990;3:73-82.
5. Berkelman R, Karon J, Thomas P, Kerndt P, Rutherford G, Stehr-Green J. Are
AIDS cases among homosexual males leveling? (Abstract). V International
Conference on AIDS. Montreal, June 4-9, 1989:66.
6. Gail MH, Rosenberg PS, Goedert JJ. Therapy may explain recent deficits in
AIDS incidence. J AIDS 1990 (in press).
7. Ward JW, Holmberg SD, Allen JR, et al. Transmission of human
immunodeficiency virus (HIV) by blood screened as negative for HIV antibody. N
Engl J Med 1988;318:473-8.
*The U.S. map will appear quarterly in the MMWR. More detailed information on
AIDS cases is provided in the monthly HIV/AIDS Surveillance Report, including
an expanded 1989 year-end summary issued January 1990; single copies are
available free from the National AIDS Information Clearinghouse, P.O. Box
6003, Rockville, MD 20850.
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Volume 3, Number 6 February 25, 1990
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David Canzi