Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1996 Feb;164(2):122–129.

Human immunodeficiency virus disease in California. Effects of the 1993 expanded case definition of the acquired immunodeficiency syndrome.

J A Singleton 1, F Tabnak 1, J Kuan 1, G W Rutherford 1
PMCID: PMC1303383  PMID: 8775725

Abstract

On January 1, 1993, the case definition of the acquired immunodeficiency syndrome (AIDS) in adults and adolescents used for monitoring the AIDS epidemic in California was expanded to include persons infected with the human immunodeficiency virus (HIV) with CD4 T-lymphocyte counts of less than 200 x 10(6) per liter (< 200 per mm3), pulmonary tuberculosis, recurrent pneumonia, or invasive cervical cancer. To assess the implications of this revision on AIDS case reporting in California, we compared cases reported through the end of 1994 based on 1 or more of the 4 new AIDS-defining conditions added in 1993 to cases reported based on pre-1993 AIDS-defining opportunistic infections and cancers. The 4 new conditions included in the 1993 expanded AIDS case definition accounted for a 23% increase in cumulative AIDS cases reported in California by the end of 1993, a 170% increase in the number of cases reported during 1993, and an 88% increase in the number of patients with AIDS living at the end of 1993. The number of cases reported in 1993 (19,629) was 124% more than that reported in 1992 (8,780) and 69% more than that reported in 1994 (11,587). The proportion of cases among women, injection-drug users, and African Americans also increased as a result of this change in the case definition. The expansion of the case definition may have resulted in a peak or plateau in the AIDS incidence in California because of reporting earlier in the HIV disease progression. The expanded case definition has enhanced the usefulness of AIDS surveillance data for targeting secondary prevention efforts, but more behavioral and HIV serosurveys are still needed to adequately target primary HIV prevention efforts.

Full text

PDF
122

Images in this article

124Figure 1.
on p.124

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alcabes P., Muñoz A., Vlahov D., Friedland G. H. Incubation period of human immunodeficiency virus. Epidemiol Rev. 1993;15(2):303–318. doi: 10.1093/oxfordjournals.epirev.a036122. [DOI] [PubMed] [Google Scholar]
  2. Bacchetti P. The impact of lengthening AIDS reporting delays and uncertainty about underreporting on incidence trends and projections. J Acquir Immune Defic Syndr. 1994 Aug;7(8):860–865. [PubMed] [Google Scholar]
  3. Buehler J. W., Ward J. W. A new definition for AIDS surveillance. Ann Intern Med. 1993 Mar 1;118(5):390–392. doi: 10.7326/0003-4819-118-5-199303010-00012. [DOI] [PubMed] [Google Scholar]
  4. Chaisson R. E., Stanton D. L., Gallant J. E., Rucker S., Bartlett J. G., Moore R. D. Impact of the 1993 revision of the AIDS case definition on the prevalence of AIDS in a clinical setting. AIDS. 1993 Jun;7(6):857–862. doi: 10.1097/00002030-199306000-00015. [DOI] [PubMed] [Google Scholar]
  5. Chang S. W., Kate M. H., Hernandez S. R. The new AIDS case definition. Implications for San Francisco. JAMA. 1992 Feb 19;267(7):973–975. [PubMed] [Google Scholar]
  6. Collier A. C. Early intervention in HIV infection: where are we? AIDS Res Hum Retroviruses. 1994 Aug;10(8):893–899. doi: 10.1089/aid.1994.10.893. [DOI] [PubMed] [Google Scholar]
  7. Des Jarlais D. C., Wenston J., Friedman S. R., Sotheran J. L., Maslansky R., Marmor M., Yancovitz S., Beatrice S. Implications of the revised surveillance definition: AIDS among New York City drug users. Am J Public Health. 1992 Nov;82(11):1531–1533. doi: 10.2105/ajph.82.11.1531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Francis D. P., Singleton J. A. Reporting of HIV-1 infection through the provision of essential services. J Acquir Immune Defic Syndr. 1993 Mar;6(3):285–286. [PubMed] [Google Scholar]
  9. Jones J. L., Hanson D. L., Chu S. Y., Fleming P. L., Hu D. J., Ward J. W. Surveillance of AIDS-defining conditions in the United States. Adult/Adolescent Spectrum of HIV Disease Project Group. AIDS. 1994 Oct;8(10):1489–1493. doi: 10.1097/00002030-199410000-00018. [DOI] [PubMed] [Google Scholar]
  10. Pantaleo G., Menzo S., Vaccarezza M., Graziosi C., Cohen O. J., Demarest J. F., Montefiori D., Orenstein J. M., Fox C., Schrager L. K. Studies in subjects with long-term nonprogressive human immunodeficiency virus infection. N Engl J Med. 1995 Jan 26;332(4):209–216. doi: 10.1056/NEJM199501263320402. [DOI] [PubMed] [Google Scholar]
  11. Payne S. F., Rutherford G. W., Lemp G. F., Clevenger A. C. Effect of the revised AIDS case definition on AIDS reporting in San Francisco: evidence of increased reporting in intravenous drug users. AIDS. 1990 Apr;4(4):335–339. doi: 10.1097/00002030-199004000-00008. [DOI] [PubMed] [Google Scholar]
  12. Rosenberg P. S., Goedert J. J., Biggar R. J. Effect of age at seroconversion on the natural AIDS incubation distribution. Multicenter Hemophilia Cohort Study and the International Registry of Seroconverters. AIDS. 1994 Jun;8(6):803–810. doi: 10.1097/00002030-199406000-00013. [DOI] [PubMed] [Google Scholar]
  13. Selik R. M., Buehler J. W., Karon J. M., Chamberland M. E., Berkelman R. L. Impact of the 1987 revision of the case definition of acquired immune deficiency syndrome in the United States. J Acquir Immune Defic Syndr. 1990;3(1):73–82. [PubMed] [Google Scholar]
  14. Singleton J. A., Otten M. W., Jr, Doebbert G., Kizer K. W. Premature mortality related to HIV infection in California 1981-1993. J Acquir Immune Defic Syndr. 1992;5(7):688–693. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES