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INFECTIOUS DISEASE

BACTERIOLOGY IMMUNOLOGY MYCOLOGY PARASITOLOGY VIROLOGY

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VIROLOGY - CHAPTER  SEVEN    

PART FIVE

HUMAN IMMUNODEFICIENCY VIRUS AND AIDS  

STATISTICS

Dr Richard Hunt

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world-death.gif (21693 bytes) Leading causes of death worldwide WHO

Figure 9


AIDS is currently defined in persons older than 13 years as the presence of one of 25 conditions indicative of severe immunosuppression or HIV infection in an individual with a CD4+ cell count of less than 200 cells per cubic mm of blood. AIDS is the end point of an infection that is continuous, progressive and pathogenic. With the prevalence of HIV in the developing world, HIV and its complications will be with us for many generations to come. AIDS is now a leading cause of death worldwide (figure 9).

Total number of HIV-infected people in the world December 2004 (UNAIDS) Total number of HIV-infected people in various regions December 2004 (UNAIDS) Total number of HIV-infected women in the world December 2004 (UNAIDS) Proportion of HIV-infected people who are female 1985-2004 in various regions (UNAIDS)

 

How is AIDS defined in people over 13 years of age? How is AIDS defined in people under 13 years of age? How much does HIV treatment cost and how long does the patient on HAART survive?  

There are about 33.2 million (estimate range: 30.6 million - 36.1 million) HIV-infected people in the world of whom about 22.5 million (range: 20.9 million - 24.3 million) are in sub-Saharan Africa where the adult infection prevalence is about 6%.

Approximately 14,000 new HIV infections occur daily around the world and over 90% of these are in developing countries. One thousand are in children less than 15 years of age. Of adult infections, 40% are in women and 15% in individuals of 15 - 25 years of age. Perinatal infection has resulted in a large number of children being born with HIV. 30-50% of mother to child transmissions of HIV results from breast feeding and about a quarter of babies born to HIV-infected mothers are themselves infected.

 

epidemic.gif (21933 bytes)  Evolution of an epidemic. Estimated AIDS incidence in the US through 2000
Figure 10A

 

trend9-98-age.gif (29331 bytes) AIDS Cases by Age and Sex, Reported 1981-1998, United States  CDC
Figure 10B

Estimated Number of Adults and Adolescents Living with AIDS, by Sex, 1993 - 2001, United States. CDC
Figure 10C
 

United States Statistics from Centers for Disease Control

Total number of HIV-infected people

In October 2008, CDC released new estimates of the extent of the HIV/AIDS epidemic. These showed that 1,106,400 adults and adolescents were living with HIV infection in the United States at the end of 2006 (95% Confidence Interval: 1,056,400–1,156,400). This compares with approximately 994,000 infected Americans at the end of 2003 and 641,086 in 1996. Thus, HIV prevalence increased by approximately 112,000 (or 11%) from 2003 to 2006. This increase was expected and was the result of anti-retroviral treatment which greatly extends life and because more people become infected with HIV than die from the disease each year. Infected men heavily outnumber women with 828,000 cases in males and 278,400 cases in females (figure 10B).

Seventy percent of HIV-infected people in 2006 were between the ages of 25 and 49 (770,000 persons), 25% were age 50 and older (280,000 persons), and 5% were between the ages of 13 and 24 (56,500 persons). Approximately, 10,000 cases were estimated in children under age 13.

Nearly half of all people living with HIV in the U.S. in 2006 (48%, or 532,000 total persons) were men who have sex with men.


New infections

It was estimated that 56,300 people were newly infected with HIV in 2006 and 53% of these new infections occurred in gay and bisexual men.

 

Cumulative cases by race/ethnicity in United States Cumulative cases by exposure category Estimated number of diagnoses among children by exposure category in US Leading states reporting highest number of AIDS cases in US


Patients with AIDS

In 2006, the estimated number of persons living with AIDS (i.e. overt disease rather than infection by the virus) in the United States and dependent areas was 448,871. In the 50 states and the District of Columbia, this included 432,915 adults and adolescents, and 3,775 children under age 13 years.

In the early years of the epidemic, AIDS incidence increased by 65-95% each year but partly as a result of prevention efforts targeting those at highest risk, the rate of increase fell to less than 5% per year by the mid 1990's. This was prior to the introduction of combination therapies for HIV.  In 1996, estimated AIDS incidence dropped for the first time, declining 6%. Deaths among people with AIDS also declined for the first time in 1996, dropping 25% (Figure 10A) (More information).
 

How are AIDS cases in the US distributed among various population groups?

How has the incidence of AIDS declined in the US in recent years?

Note: As more and more people survive with an HIV infection because of successful chemotherapeutic intervention, the number of infectious people in the population is rising even though fewer people are dying of AIDS (figure 10C). Thus, if declines in AIDS deaths continue, there will also be an increase in HIV prevalence, pointing to an increased need for both prevention and treatment services.

Deaths in the United States

At least  565,927 infected Americans have died of AIDS (2006 numbers). Of these, 540,436 were adults or adolescents and 5,369  were children under 13.

 

MORE US STATISTICAL INFORMATION

 


 

AIDS CASES BY AGE AND ETHNICITY IN THE UNITED STATES

CUMULATIVE CASES OF AIDS IN THE US (by age)

AGE

# of AIDS CASES (Dec 2005)

Under 13 years 9,112
13-14 years 1,065
15-19 years 5,289
20-24 years 34,795
25-29 years 114,141
30-34 years 193,926
35-39 years 208,505
40-44 years 164,697
45-49 years 102,732
50-54 years 56,950
55-59 years 30,424
60-64 years 16,493
65 years and older 14,503
Updated October 2007  - Most recent CDC cumulative statistics are here

 

worlddeath2.gif (19240 bytes) Estimated number of AIDS related deaths worldwide 1980-2000  WHO

worlddeath3.gif (22487 bytes) Mother to child transmission of HIV 1979-1999 by breast-feeding or other cause   WHO 

africanwomen.jpg (56316 bytes)  HIV prevalence among pregnant women in South African provinces 1990-97

unaids-stats.jpg (44575 bytes)  HIV prevalence rate among teenagers in Kisumu, Kenya, by age  UNAIDS
 

unaids-stats2.jpg (66425 bytes) HIV prevalence rate among women in their teens and twenties, various African studies 1995-98 UNAIDS

unaids-stats4.jpg (72336 bytes) Changes in life expectancy in selected African countries with high HIV prevalence, 1950-2000 UNAIDS

Figure 11

CUMULATIVE CASES BY ETHNICITY
(Estimated number of cases in 2006 in parentheses)

Race or ethnicity Cumulative AIDS cases
White, not Hispanic  394,024 (10,929)
Black, not Hispanic  409,982 (17,960)
Hispanic  161,505 (6,907)
Asian/Pacific Islander  7,951 (519)
American Indian/Alaska Native 3,345 (155)
Updated October 2008 (data to 2006) - Most recent CDC cumulative statistics are here



World Statistics from The World Health Organization and UNAIDS

HIV infections have leveled off in the west and the wave of infections threatening to affect western heterosexuals has not materialized. However, this is not the case elsewhere and there have been huge increases in southern Asia and southern Africa.  
 

Africa

In sub-Saharan Africa, there are an estimated 22.5 million (range: 20.9 million–24.3 million; 2007 figures) people infected by HIV with over 2.8 million new infections in 2006. In this region, there were 2.1 million deaths (figure 11 and 12). Ten million young Africans between the ages of 15 and 24 and 3 million children are infected.  In contrast to western countries, young African women are more likely to be infected with HIV than young men. According to UNAIDS, 61% of HIV-infected people in sub-Saharan Africa are female and the gap is increasing. Women are being infected with HIV at an earlier age than men in most countries in sub-Saharan Africa. The differences in infection levels are most pronounced among young people (aged 15 – 24 years) with, on average, 36 young women living with HIV for every 10 young men in sub-Saharan Africa.

AIDS is responsible for a decrease in life expectancy and increase in child mortality (figure 11). Child mortality rates in East Africa will double by 2010 and adult life expectancy has already declined by 2 years in that region. 

The overall infection rate for adults in sub-Saharan Africa in 2006 was 5.9% but several countries in sub-Saharan Africa report infection rates of over 30% in urban areas. In some Kenyan and Zambian towns, 1 in 5  girls is HIV-positive by the age of 20. In men over 25, the percentage who are HIV-infected can be as high as 40%. In Botswana, the proportion of the adult population living with HIV has more than doubled over the last six years, with almost half of pregnant women testing HIV-positive in the major urban center of Francistown. (For further statistics see figure 13).

Asia-Pacific

In 2006, about 1 million people in the Asia/Pacific region became infected by HIV and 630,000 people died. The total infected population in this region is an estimated 4.9 million people (range 3.7 million - 6.7 million). Of these, 2.1 million are age 15 to 24 years and 2.4 million are women (up 21% since 2004). In this region, HIV is increasing at a rate of 10% per year. In India, the infection rate is under 1% but this means that there were 5.1 million infected people which puts India behind only South Africa in total number of cases. Much of the Indian epidemic of HIV infection results from intravenous drug use.

China also has a severe problem with up to 1.5 million HIV-infected people in 2004 (prevalence rate: 0.1%). It is predicted that if nothing is done to prevent the increasing infection rate, China will have 10 million cases by 2010.

Access to treatment in low to middle income countries

According the the WHO, just 2.9 million HIV-infected people were receiving anti-retroviral drugs in 2007. Although this is a considerable increase over previous years, it still represents a minority of patients who need the drugs. In sub-Saharan Africa coverage is approximately 30% (2.1 million out of 7 million).

 

Why are young African women more likely to be HIV-infected? Which countries in Africa have the highest infection rates? Why has Uganda succeeded in reducing the rate of HIV-infection and reversing the fall in life expectancy? More UNAIDS information on HIV infection rates in Africa Why is AIDS spreading so rapidly in some countries?

 

Chemotherapy and pediatric HIV infection in developing countries Widespread ignorance among girls and women concerning HIV and sex     What is responsible for the downward revision of HIV prevalence in 2007?


 

 
hiv infect map.jpg (50694 bytes)  

HIV infection statistics by continent
Figure 12A

Global and sub-Saharan Africa AIDS Epidemic
Figure 12B

Spread of HIV infections in South Africa 1986-2001
(animated)

Spread of HIV infections in South America 1986-2001
(animated)

WEB RESOURCES

For the latest (November 2007) WHO statistics go here

UNAIDS fact sheet 2007
Key Facts

PDF

Explanation of revised 2007 estimates
PDF

UNAIDS

Figure 13

HIV prevalence in adults in sub-Saharan Africa, 1986-2001

Number of people living with HIV/AIDS
in sub-Saharan Africa, 1980-2001
Number of people who died from HIV/AIDS in sub-Saharan Africa, 1980-2001 HIV prevalence among pregnant women in South Africa, 1990 to 2001 Kenya: HIV prevalence for adults and pregnant women Major urban and outside major urban areas HIV prevalence rates among pregnant women attending antenatal clinics in urban sites in Cameroon: 1989-2000
Senegal: HIV prevalence for pregnant women Major urban and outside major urban areas Percentage of workforce lost to AIDS by 2005 and 2020 in selected African countries HIV prevalence by educational level  aged 15-44, Zimbabwe, 2000 Prevalence among pregnant women in major urban areas, Uganda HIV prevalence rate among teenagers
by age in Kisumu, Kenya
Projected population structure with
and without the AIDS epidemic, Botswana, 2020
Increase in mortality among men between
15 and 60, selected African countries, 1986-1997
Adult mortality attributable to HIV, community- based studies in Africa, 1990-1996 Probability of a Zimbabwean boy aged 15
dying before age 50, trends over time,  various national surveys
Estimated impact of AIDS on under-5 child
mortality rates, selected African countries, 2010
Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950 - 2005 Lifetime risk of AIDS death for 15-year-old boys,
assuming unchanged or halved risk
of becoming infected with HIV, selected countries
Leading causes of death in Africa, 2000 Estimated and projected deaths at ages 15-34, with and without AIDS in South Africa: 1980-2025 Percentage of 15-19 girls who do not know that a HIV-infected person may look healthy, 1994-1999 HIV prevalence rate among 13 to 19-year-olds Masaka, Uganda, 1989 to 1997 HIV prevalence rate among pregnant
15 to 19-year-olds, Lusaka, Zambia, 1993 to 1998
Prevalence among pregnant women, outside major urban areas, Uganda
Trends in HIV prevalence among pregnant women in Kampala, Uganda: 1991-2000 HIV prevalence (%) in adults in Africa, 2005 HIV prevalence (%) among pregnant women attending antenatal clinics in sub-Saharan Africa, 1997/98-2004
 
HIV prevalence (%) by gender and urban/rural residence,
selected sub-Saharan African countries, 2001-2005
 
   
Images on the above five rows from WHO/UNAIDS

 

OTHER SECTIONS ON HIV

PART I HUMAN IMMUNODEFICIENCY VIRUS AND AIDS

PART II HIV AND AIDS, THE DISEASE

PART III COURSE OF THE DISEASE

PART IV COFACTORS

PART V STATISTICS

PART VI  SUBTYPES AND CO-RECEPTORS

PART VII  COMPONENTS AND LIFE CYCLE OF HIV

PART VIII  LATENCY OF HIV

PART IX GENOME OF HIV

PART X  LOSS OF CD4 CELLS

PART XI   POPULATION POLYMORPHISM

APPENDIX I  ANTI-HIV VACCINES

APPENDIX II  DOES HIV CAUSE AIDS?

APPENDIX III  ANTI-HIV CHEMOTHERAPY

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