HIV/AIDS demographics in US county and southeast England are similar

Editor—Sabin et al report that an increasing minority of people from six HIV treatment centres in southeast England may need newer antiretroviral treatment to offset exhaustion of existing treatment options.¹ I compared the demographics of their cohort with a much smaller, but growing population of identified HIV infected people from Dauphin County, Pennsylvania, United States.

Dauphin County is in southeast central Pennsylvania, an eastern US state adjacent to and south of New York and two hours by car north northwest of Washington, DC. The county is 525 square miles, with an estimated 2003 population of 253 388. The racial breakdown, according to the 2000 census, is 77.1% white, 16.9% black or Afro-American, 4.1% Hispanic, and 2% Asian.² Some 14.2% of the population is over the age of 65. The median yearly household income in 1999 was reported as $41 507 (£22 546; €32 924) Slightly less than 10% of the population lives below the poverty line.²

From the HIV/AIDS Surveillance Bureau-Bureau of Epidemiology, Pennsylvania Department of Health, 401 cases were identified in the county in 2003, of which 289 were male.³ The number of cases has increased steadily from 283 cases identified in 1998. Forty seven per cent of the 2003 total cases were white (non-Hispanic), 41% were Afro-American, and 12% were Hispanic. The identified modes of transmission of the 401 cases were from men having sex with men (39%), intravenous drug use (27%), heterosexual sex (21%), and men having sex with men who were also injecting drug users (8%); the remaining four cases were undetermined or other causes (two), a coagulation disorder (one), and paediatric (one). Seventy three percent of cases were first diagnosed in people aged 30-49 and another 17% in those aged 20-29.³

The population of people living with AIDS in Dauphin County faces the same problems identified by Sabin et al. Newer drugs with lower toxicity and less cross resistance are also needed here.