The United States has a comprehensive system of HIV surveillance, including case reporting and disease staging, estimates of incidence, behavioral, and clinical indicators and monitoring of HIV-related mortality. These data are used to monitor the epidemic and to better design, implement, and evaluate public health programs.
We describe HIV-related surveillance systems and review recent data.
There are more than 1.1 million people living with HIV in the United States, and approximately 56,000 new HIV infections annually. Risk behavior data show that 47% of men who have sex with men engaged in unprotected anal intercourse in the past year, and 33% of injection drug users had shared syringes. One third (32%) of people diagnosed with HIV in 2008 were diagnosed with AIDS within 12 months, indicating missed opportunities for care and prevention. An estimated 72% of HIV-diagnosed persons received HIV medical care within 4 months of initial diagnosis.
Conducting accurate and comprehensive HIV surveillance is critical for measuring progress toward the goals of the 2010 National HIV/AIDS Strategy: reduced HIV incidence, increased access to care, and improvements in health equity.
"In the United States, encephalitis has been associated with a substantial disease burden and considerable mortality –. In the last decade, West Nile Virus has emerged as an important viral cause of encephalitis , , the demographics of the HIV/AIDS epidemic have changed dramatically , , and there is increasing focus by clinicians and researchers on non-infectious etiologies –. Additionally, the general U.S. healthcare environment has evolved and there is increasing scrutiny of patient outcomes , . "
[Show abstract][Hide abstract] ABSTRACT: Background
Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States.
Using the Nationwide Inpatient Sample (NIS) from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years) hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study.
In the U.S. from 2000–2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1–7.6). Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000) and those <1 year and >65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%), followed by Other Specified causes (32.5%), which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR] = 1.70; 95% CI: 1.30–2.22 and OR = 2.26; 95% CI: 1.88–2.71, respectively). Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis.
While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st Century, the reported demographics of hospitalized encephalitis patients may be changing.
PLoS ONE 09/2014; 9(9):e104169. DOI:10.1371/journal.pone.0104169 · 3.23 Impact Factor
"The burden of bloodborne disease in the United States falls disproportionately on those living in the South (Lansky et al., 2010; Qian et al., 2006), which has higher HIV and hepatitis C (HCV) incidence rates and more people living with HIV than any other region (Centers for Disease Control and Prevention, 2013a,b,c,d; Zou et al., 2010). In 2011, North Carolina had the country's 8th highest HIV incidence rate, the 12th highest number of cumulative AIDS cases, and an HCV incidence rate 50% greater than the national average (Centers for Disease Control and Prevention, 2013a,b,c,d; North Carolina Division of Public Health, 2013). "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: North Carolina, like much of the U.S. South, is disproportionately affected by HIV and hepatitis. This persistently high disease burden may be driven in part by laws that criminalize the possession and distribution of syringes for illicit drug use. Legal change to decriminalize syringes may reduce infection rates in the state, but is unlikely absent support from law enforcement actors.
METHODS: We analyzed the responses of 350 North Carolina law enforcement officers to a confidential, anonymous survey. The survey instrument collected data regarding self-reported needle-stick injury (NSI), blood borne disease risk perception and attitudes toward syringe decriminalization.
RESULTS: 82% of respondents reported that contracting HIV was a "big concern" for them. 3.8% of respondents reported ever receiving a job-related NSI, a rate of 36 NSI per 10,000 officer-years. Majorities of respondents reported positive views regarding syringe decriminalization, with approximately 63% agreeing that it would be "good for the community" and 60% agreeing that it would be "good for law enforcement." Black and female officers were significantly less likely to agree that on-the-job NSI was a "big concern" and significantly more likely to agree that it would be good for law enforcement.
CONCLUSIONS: These findings suggest that many North Carolina LEOs understand the public health benefits of syringe access programs and may be inclined to support syringe decriminalization legislation. Further research is indicated to determine the causes of observed differences in perceptions of bloodborne disease risk and attitudes toward syringe decriminalization by race and sex.
Drug and Alcohol Dependence 08/2014; 144. DOI:10.1016/j.drugalcdep.2014.08.007 · 3.42 Impact Factor
"Human immunodeficiency virus (HIV) remains a major public health problem in the United States with 56,000 new HIV infections per year . The current prevalence of HIV infection in the United States is estimated to be over one million with a disproportionate distribution among minorities, and a reemerging HIV/AIDS epidemic in gay men [2-4]. "
[Show abstract][Hide abstract] ABSTRACT: HIV retinopathy is the most common non-infectious complication in the eyes of HIV-positive individuals. Oncotic lesions in the retinal nerve fiber layer, referred to as cotton wool spots (CWS), and intraretinal (IR) hemorrhages are frequently observed but are not unique to this pathology. HIV-positive patients have impaired color vision and contrast sensitivity, which worsens with age. Evidence of inner-retinal lesions and damage have been documented ophthalmoscopically, however their long term structural effect has not been investigated. It has been hypothesized that they may be partially responsible for loss of visual function and visual field. In this study we utilized clinical data, retinal imaging and transcriptomics approaches to comprehensively interrogate non-infectious HIV retinopathy. The methods employed encompassed clinical examinations, fundus photography, indirect ophthalmoscopy, Farmsworth-Munsell 100 hue discrimination testing and Illumina BeadChip analyses. Here we show that changes in the outer retina, specifically in the retinal pigment epithelium (RPE) and photoreceptor outer segments (POS) contribute to vision changes in non-infectious HIV retinopathy. We find that in HIV-positive retinae there is an induction of rhodopsin and other transcripts (including PDE6A, PDE6B, PDE6G, CNGA1, CNGB1, CRX, NRL) involved in visual transduction, as well as structural components of the rod photoreceptors (ABCA4 and ROM1). This is consistent with an increased rate of renewal of rod outer segments induced via increased phagocytosis by HIV-infected RPE previously reported in culture. Cone-specific transcripts (OPN1SW, OPN1LW, PDE6C, PDE6H and GRK7) are uniformly downregulated in HIV positive retina, likely due to a partial loss of cone photoreceptors. Active cotton wool spots and intraretinal hemorrhages (IRH) may not affect photoreceptors directly and the interaction of photoreceptors with the aging RPE may be the key to the progressive vision changes in HIV-positive patients.
PLoS ONE 09/2013; 8(9):e74712. DOI:10.1371/journal.pone.0074712 · 3.23 Impact Factor
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