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HIV Infection Reporting -- United States
Publication date: 07/21/1989
Table of Contents
ArticleAll 50 states and the District of Columbia require health-care providers to report new cases of acquired immunodeficiency syndrome (AIDS) to their state health departments. As of July 1989, 28 (56%) states also required reporting of persons infected with human immunodeficiency virus (HIV) (Figure 1). In addition, 10 states (as of May 1989) have proposals on reporting currently before their legislatures, governors, or voting constituencies.
The 28 states that require HIV infection reporting account for 45% of the U.S. population and 24% of U.S. AIDS cases reported as of June 30, 1989. States with HIV infection reporting had a lower median cumulative incidence of AIDS (388 AIDS cases per state or 14 cases per 100,000 population) than states without reporting (1244 AIDS cases per state or 31 cases per 100,000 population). Thirteen (46%) states with HIV infection reporting had greater than 500 cumulative AIDS cases, compared with 14 (64%) states without reporting.
Reporting systems among the 28 states have been developed independently and therefore vary widely in methodology and information collected. In 21 (75%) states, reporting is the responsibility of both the physician caring for the patient and the laboratory that tested the patient's blood for HIV antibody. In five (18%) states, reporting is the physician's responsibility alone, and in two (7%) states, it is the laboratory's responsibility alone. Twenty (71%) states require a positive result on a supplemental test (Western blot or immunofluorescence assay) in addition to a repeatedly reactive enzyme immunoassay (EIA) before a patient is reported; three (11%) states will accept reports on patients repeatedly reactive on EIA; five (18%) states will accept reports on patients reactive on an initial EIA. All states, however, recommend supplemental testing before patient follow-up or initiation of partner notification procedures. Eighteen (64%) of the 28 states require HIV reporting by patient's name (Figure 1); however, under certain circumstances, 10 of the 18 states permit anonymous testing and therefore do not receive names on some reports. Most states request basic demographic data, and more than half request HIV risk information. Twelve (43%) collect clinical information, e.g., eight (29%) ask whether the patient was symptomatic, and four (14%) collect sufficient information to allow use of the CDC HIV infection classification system (1).
Reported by: State and territorial health departments. AIDS Program, Center for Infectious Diseases, CDC.
Editorial NoteEditorial Note: HIV infection reports are useful in directing HIV-related prevention activities such as patient counseling, partner notification, and referral for appropriate medical management (e.g., evaluation for prophylaxis against Pneumocystis carinii pneumonia (2)). Reporting of HIV-infected persons may enable earlier recognition of persons with or at risk for HIV infection and earlier interventions to prevent further spread of HIV. Recent guidelines for initiation of therapy in some HIV-infected persons emphasize the need for identifying persons who need treatment before the diagnosis of AIDS is made (2). HIV infection reports are also useful for guiding pediatric medical and social support programs, including programs for infants whose infection status may remain undetermined until they are greater than or equal to 15 months of age (3). Prevention activities and medical management of patients can be carried out without requiring HIV infection reporting (4), but a reporting system can provide a framework for maintaining these activities.
HIV infection reports that are now integral to public health programs in many states are not anticipated to be representative of all HIV-infected persons. Such reports represent only those persons within the infected population who are tested and reported at a given time. Testing and reporting may be influenced by factors other than the incidence and prevalence of AIDS, e.g., public awareness of risk factors, confidentiality concerns, and testing accessibility. While HIV infection reports complement other HIV/AIDS studies of HIV infection in a community (5,6), AIDS surveillance and the HIV family of surveys (7) remain the basis for determining the current status and course of HIV infection in the United States.
In February 1989, CDC conducted a workshop for all states that had had HIV infection reporting for at least 1 year and selected states that had initiated reporting more recently or were considering initiating reporting. The workshop addressed standardization of HIV infection reports to increase their usefulness and to enable a comparison of results between states. Participants developed recommendations for states with HIV infection reporting (Table 1) and affirmed the continued need for AIDS surveillance and HIV serosurveys.
- CDC. Classification system for human T-lymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR 1986;35:334-9.
- CDC. Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR 1989;38(no. S-5).
- CDC. Classification system for human immunodeficiency virus (HIV) infection in children under 13 years of age. MMWR 1987;36:225-30,236.
- Blankenship EM, Owen-O'Dowd JM, Jolly DH, Petz WJ, Meriwether RA. HIV partner notification within an anonymous testing system (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:743.
- Hoffman RE, Valway SE, Wolf FC, et al. Comparison of AIDS and HIV antibody surveillance data in Colorado. J Acquired Immune Deficiency Syndromes 1989;2:194-200.
- MacDonald K, Danila R, Reier D, Heiser J, Stiepan D, Osterholm M. Surveillance for HIV infection in Minnesota: results from the first three years of operation (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:59.
- CDC. AIDS and human immunodeficiency virus infection in the United States: 1988 update. MMWR 1989;38(no. S-4):8-11.
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