This Article  • Full text  • PDF  • eMethods  • JAMA Report Video  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (65)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • HIV/AIDS  • Public Health, Other  • Statistics and Research Methods  • Diagnosis  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

H. Irene Hall, PhD; Ruiguang Song, PhD; Philip Rhodes, PhD; Joseph Prejean, PhD; Qian An, MS; Lisa M. Lee, PhD; John Karon, PhD; Ron Brookmeyer, PhD; Edward H. Kaplan, PhD; Matthew T. McKenna, MD; Robert S. Janssen, MD; for the HIV Incidence Surveillance Group

JAMA. 2008;300(5):520-529.

Context  Incidence of human immunodeficiency virus (HIV) in the United States has not been directly measured. New assays that differentiate recent vs long-standing HIV infections allow improved estimation of HIV incidence.

Objective  To estimate HIV incidence in the United States.

Design, Setting, and Patients  Remnant diagnostic serum specimens from patients 13 years or older and newly diagnosed with HIV during 2006 in 22 states were tested with the BED HIV-1 capture enzyme immunoassay to classify infections as recent or long-standing. Information on HIV cases was reported to the Centers for Disease Control and Prevention through June 2007. Incidence of HIV in the 22 states during 2006 was estimated using a statistical approach with adjustment for testing frequency and extrapolated to the United States. Results were corroborated with back-calculation of HIV incidence for 1977-2006 based on HIV diagnoses from 40 states and AIDS incidence from 50 states and the District of Columbia.

Main Outcome Measure  Estimated HIV incidence.

Results  An estimated 39 400 persons were diagnosed with HIV in 2006 in the 22 states. Of 6864 diagnostic specimens tested using the BED assay, 2133 (31%) were classified as recent infections. Based on extrapolations from these data, the estimated number of new infections for the United States in 2006 was 56 300 (95% confidence interval [CI], 48 200-64 500); the estimated incidence rate was 22.8 per 100 000 population (95% CI, 19.5-26.1). Forty-five percent of infections were among black individuals and 53% among men who have sex with men. The back-calculation (n = 1.230 million HIV/AIDS cases reported by the end of 2006) yielded an estimate of 55 400 (95% CI, 50 000-60 800) new infections per year for 2003-2006 and indicated that HIV incidence increased in the mid-1990s, then slightly declined after 1999 and has been stable thereafter.

Conclusions  This study provides the first direct estimates of HIV incidence in the United States using laboratory technologies previously implemented only in clinic-based settings. New HIV infections in the United States remain concentrated among men who have sex with men and among black individuals.

Author Affiliations: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Hall, Song, Rhodes, Prejean, Lee, McKenna, and Janssen); The Ginn Group Inc, Peachtree City, Georgia (Ms An); Emergint Corporation, Louisville, Kentucky (Dr Karon); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Brookmeyer); and Yale School of Management, Department of Epidemiology and Public Health, Yale School of Medicine, and Yale School of Engineering and Applied Science, New Haven, Connecticut (Dr Kaplan). Dr Janssen is now with Gilead Sciences Inc, Foster City, California.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Mass Media as an HIV-Prevention Strategy: Using Culturally Sensitive Messages to Reduce HIV-Associated Sexual Behavior of At-Risk African American Youth
Romer et al.
AJPH 2009;99:2150-2159.
ABSTRACT | FULL TEXT  

Intimate partner violence perpetration, standard and gendered STI/HIV risk behaviour, and STI/HIV diagnosis among a clinic-based sample of men
Decker et al.
Sex. Transm. Infect. 2009;85:555-560.
ABSTRACT | FULL TEXT  

HIV/AIDS--Still a Force to Be Reckoned With: Call for Papers
Zuccotti and Smith
JAMA 2009;302:2259-2259.
FULL TEXT  

Recommendations From a Research Consultation to Address Intervention Strategies for HIV/AIDS Prevention Focused on African Americans
Purcell and McCree
AJPH 2009;99:1937-1940.
ABSTRACT | FULL TEXT  

Investing To Meet The Scientific Challenges Of HIV/AIDS
Fauci and Folkers
Health Aff (Millwood) 2009;28:1629-1641.
ABSTRACT | FULL TEXT  

Postexposure Prophylaxis for HIV Infection
Landovitz and Currier
NEJM 2009;361:1768-1775.
FULL TEXT  

A Review of the Centers for Disease Control and Prevention's Response to the HIV/AIDS Crisis Among Blacks in the United States, 1981-2009
Sutton et al.
AJPH 2009;99:S351-S359.
ABSTRACT | FULL TEXT  

Implementation of and Barriers to Routine HIV Screening for Adolescents
Minniear et al.
Pediatrics 2009;124:1076-1084.
ABSTRACT | FULL TEXT  

Risk behaviours in HIV-positive men who have sex with men participating in an intervention in a primary care setting
Bachmann et al.
Int J STD AIDS 2009;20:607-612.
ABSTRACT | FULL TEXT  

Sexual partner concurrency among STI clinic patients with a steady partner: correlates and associations with condom use
Senn et al.
Sex. Transm. Infect. 2009;85:343-347.
ABSTRACT | FULL TEXT  

HIV-1 Envelope Induces Memory B Cell Responses That Correlate with Plasma Antibody Levels after Envelope gp120 Protein Vaccination or HIV-1 Infection
Bonsignori et al.
J. Immunol. 2009;183:2708-2717.
ABSTRACT | FULL TEXT  

Genome-Wide Screen Identifies Drug-Induced Regulation of the Gene Giant Axonal Neuropathy (Gan) in a Mouse Model of Antiretroviral-Induced Painful Peripheral Neuropathy
Dorsey et al.
Biol Res Nurs 2009;11:7-16.
ABSTRACT  

New Guidelines for the Management of HIV-Related Opportunistic Infections
Masur and Kaplan
JAMA 2009;301:2378-2380.
FULL TEXT  

Addressing the Unique Needs of African American Women in HIV Prevention
El-Bassel et al.
AJPH 2009;99:996-1001.
ABSTRACT | FULL TEXT  

Accessing Social Networks With High Rates of Undiagnosed HIV Infection: The Social Networks Demonstration Project
Kimbrough et al.
AJPH 2009;99:1093-1099.
ABSTRACT | FULL TEXT  

Sexual Risk Behaviors Among HIV-Positive Black Men Who Have Sex With Women, With Men, or With Men and Women: Implications for Intervention Development
Spikes et al.
AJPH 2009;99:1072-1078.
ABSTRACT | FULL TEXT  

The President's Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes
Bendavid and Bhattacharya
ANN INTERN MED 2009;150:688-695.
ABSTRACT | FULL TEXT  

Relationship between heterosexual anal sex, injection drug use and HIV infection among black men and women
Risser et al.
Int J STD AIDS 2009;20:310-314.
ABSTRACT | FULL TEXT  

Consistency of State Statutes With the Centers for Disease Control and Prevention HIV Testing Recommendations for Health Care Settings
Mahajan et al.
ANN INTERN MED 2009;150:263-269.
ABSTRACT | FULL TEXT  

CDC Recommendations for Opt-Out HIV Testing--Reply
Bartlett and Mayer
JAMA 2009;301:275-276.
FULL TEXT  

Screening for HIV in Health Care Settings: A Guidance Statement From the American College of Physicians and HIV Medicine Association
Qaseem et al.
ANN INTERN MED 2009;150:125-131.
ABSTRACT | FULL TEXT  

Subpopulation Estimates From the HIV Incidence Surveillance System--United States, 2006
JAMA 2009;301:155-156.
FULL TEXT  

Caring for AIDS Patients in the ICU: Expanding Horizons
Masur
Chest 2009;135:1-2.
FULL TEXT  

Syringe Access and HIV Incidence in the United States
Stancliff
JAMA 2008;300:2370-2370.
FULL TEXT  

The AIDS Epidemic -- A Progress Report from Mexico City
Steinbrook
NEJM 2008;359:885-887.
FULL TEXT  

New Estimate of HIV Incidence Is Disappointingly High
JWatch General 2008;2008:2-2.
FULL TEXT  

Increased Estimates of HIV Incidence in the U.S.
JWatch Infect. Diseases 2008;2008:2-2.
FULL TEXT  

The Past, Present, and Future of AIDS
Osborn
JAMA 2008;300:581-583.
FULL TEXT