Prevention Conference Reviews HIV/AIDS Trends
In August, the Centers for Disease Control and Prevention (CDC) convened the first National HIV Prevention Conference to review and respond to the latest information on national trends in HIV and AIDS rates. The four-day meeting, cosponsored by a host of other organizations from around the country, was attended by over 2,000 research scientists, practitioners and advocates.
Among the most notable trends discussed at the meeting was the decline in AIDS-related deaths. Nationally, AIDS-related deaths have dropped from a high of about 50,000 per year in 1995 to 17,000 per year in 1998. This dramatic drop over a three-year time period is attributed primarily to potent drug-combination therapies that can subdue the effects of the disease. Experts at the conference expressed deep concern, however, over new data showing that these dramatic decreases are leveling off. A slowing of this trend, they said, suggests that much of the benefit of these new therapies has now been realized. At the same time, conferees noted, it points to the need for a continuing focus on HIV prevention.
Preventive efforts have helped reduce the number of new HIV infections in the United States by over two-thirds, from more than 150,000 infections per year in the late 1980s. Still, there are about 40,000 new infections annually, and current national estimates suggest that at least one-half of these are occurring among people younger than 25. Indications of an upturn in new infections among gay men, whose adoption of risk-reduction behavior in the early years of the epidemic was particularly dramatic, were widely discussed. "The data presented...on new HIV infections is a source of great concern," said Helene Gayle, director of HIV prevention at CDC. "It shows how quickly the epidemic can reemerge when people become complacent about the need for HIV prevention."
Another, more positive finding released at the conference was that between 1992 and 1997, perinatally acquired HIV infections in the United States declined 66%. This decrease is due in large part to administration of zidovudine (ZDV, formerly known as AZT) to HIV-infected pregnant women. In 1994, ZDV was shown to have a dramatic effect in reducing HIV transmission from mother to infant. As a result, the Institute of Medicine (IOM) in 1998 revised its 1991 recommendation of "routine" counseling and the "offer" of HIV testing to pregnant women to "universal HIV testing with patient notification as a routine component of prenatal care." This recommendation was considered something of a compromise between proposals for outright mandatory and purely voluntary testing of pregnant women (TGR, Vol. 1, No. 6, December 1998). In July, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists joined forces in support of the latest IOM recommendation. Before perinatal preventive treatment services were available, an estimated 1,000-2,000 infants were born with the HIV infection each year in the United States.