2006 Indiana HIV Incidence

Richard T. PasseyIndiana State Department of HealthOffice of Clinical Data and Research

HIV Incidence Surveillance

Need for HIV Incidence Surveillance

Gives cutting edge picture of epidemic

Targets at risk populations for prevention and testing

Planners redistribute resources

New Infection of HIV Is Difficult to Pinpoint in Time

• How do we pinpoint when someone becomes infected?

– Asymptomatic window period

– Individual’s testing pattern is essential

http://www.cmsp.com/data2/fx100004.htm

Incidence Defined

The number of NEW INFECTIONS in a given time period; usually one year

HIV Incidence Defined

• Not just new HIV diagnoses

• Incidence is NEW HIV INFECTIONS– Excludes those with HIV infections longer

than one year– May be higher or lower than new HIV

diagnoses– Accounts for HIV not yet tested: about 25%– Not changed by increased or decreased

testing rates

2006 National HIV Incidence Calculation

• First Method: Point Estimate for 2006 (Reference JAMA Article)

– Laboratory Test (STARHS/BED)• Can classify infection as less than 156 days• Not for individual; for population surveillance

– Testing and Treatment History

– Core HIV Surveillance Data

2006 U.S. HIV Incidence Estimation

Point Estimate 56,30022.8/100,000 rate40% Higher than

Previous Estimate 40,00016.2/100,000

2006 U.S. HIV Incidence by Gender

73% Male34.3/100,000 rate

27% Female11.9/100,000 rate

2006 U.S. HIV Incidence by Transmission

53% Men that have Sex with Men (MSM)

12% Injection Drug User (IDU)

4% MSM/IDU

31% Heterosexual

2006 National HIV Incidence Age

13-29 34% 26.8/100,000

30-39 31% 42.6/100,000

40-49 24% 30.7/100,000

50-99 10% 6.5/100,000

National HIV Incidence by Race/Ethnicity

• 35% White• Rate 11.5/100,000

• 17% Hispanic• Rate 29.3/100,000• Almost three times the rate of white individuals

• 45% Black Individuals• Rate of 83.7/100,00 for Black• Seven times the rate of white individuals

                                                                              

Artist’s Depiction of HIV Virus Particle

2006 National HIV Incidence Calculation

• Second Method Confirmatory for STARHS

– Statistical Back Calculation Approach

• Looked at HIV incidence since 1970’s

HIV Incidence by Back Calculation for U.S.

• Incidence first noticed in 1977

• Peaked mid 80’s at 130,000

• Low point early 1990’s at 49,000

• Second peak late 90’s at 58,000

• Since 2000 stayed at roughly 55,000

One Area of Success

Overall HIV incidence among IDU has decreased 80% in the U.S.

From 35,000 in 1990 to 6,600 in 2006

Conclusions for National HIV Incidence

Racial Disparities are Greater than Expected

Incidence Rate is 40% Higher than Expected and has been for Years

Young, Black, MSM at Most Risk

Prevention, and Testing Plan

Indiana 2006 HIV Incidence

New Statewide Calculation is Cutting Edge

– STARHS Lab Test

– Core HIV Surveillance

– Testing and Treatment History

Indiana 2006 HIV Incidence(New Infections)

• Local Estimate is 639

• CDC Estimate is 700

Indiana HIV Diagnosis Compared to Incidence (Infected) for 2006

• 519 Diagnosed with HIV/AIDS • 10.0 per 100,000

• 323 Diagnosed with HIV not AIDS• 6.2 per 100,000

• 639 Incidence for HIV not AIDS • 12.3 per 100,000 (double)

• 700 Incidence for HIV not AIDS • 13.5 per 100,000

http://www.cmsp.com/data2/fx100003.htm

Indiana 2006 HIV Incidence Stratified by Gender

• Women 6.9/100,000 HIV incidence rate• 29% (187) new HIV infections (incidence)

• Men 17.5/100,000 HIV incidence rate• 71% (452) new HIV infections

Indiana 2006 HIV Incidence Stratified by Race

• White 60% of 2006 incidence

• Rate is 8.2/100,000

• Other (Minorities) 40% of incidence

• Rate is 45.8/100,000

• 5.6 times higher rate for other than white

Indiana 2006 HIV Incidence Stratified by Age

13-29 41% 17.3/100,000

30-39 35% 26.3/100,000

40+ 25% 5.6/100,000

Indiana 2006 HIV Incidence Stratified by Transmission

• MSM 55% of incidence in 2006

• Other 45%

• Could not be further separated

• Includes IDU, Heterosexual, and No Reported Risk

Conclusions on Indiana Statewide HIV Incidence

HIV Incidence Rate Double that of HIV Diagnosis Rate

Racial Disparities are Alarming

Young Minority MSM at Greatest Risk

2006 Indiana HIV Incidence Estimation ‡

           

HIV Incidence Estimate* Std. Dev.** HIV/AIDS Diagnosis***

STRATA Count % Rate/100,000 Count Count

Sex

Male 452 70.7 17.5 104 414

Female 187 29.3 6.9 63 105

Race/Ethnicity

White 380 59.5 8.2 77 280

Other 259 40.5 45.8 74 239

Diagnosis Age

13-29 261 40.8 17.3 51 176

30-39 220 34.5 26.3 55 155

40+ 158 24.7 5.6 68 188

Transmission

MSM 352 55.1 N/A 67 271

Other (IDU,HET,NRR) 287 44.9 N/A 90.7 248

Total ± 639 100.0 12.3 126 519

‡Source: Indiana State Department of Health, Office of Clinical Data and Research, January 1, 2006 to December 31, 2006; Reported through August 1, 2008

*Incidence Estimate-Estimated Number of New HIV Infections. Estimations will vary according to STRATA.

**Std. Dev-Standard Deviation of Incidence Estimate 'Count'

***HIV/AIDS Diagnosis-Newly Reported HIV/AIDS Cases to ISDH though August 31, 2008 and diagnosed January 1, 2006 – December 31, 2006

±Total-Non-Stratified (includes all variables) HIV Incidence Estimation. Each set of STRATA separately equals the number represented in the 'Total' with the exception of 'Std. Dev.'.

Other categories-Represent All Race/Ethnicity's other than Whites and All Transmissions other than MSM. Categories represented in 'Other' were too small separately to accurately estimate Incidence when stratifying.

NRR-No Reported Risk

• Bibliography • Estimation of HIV Incidence in the United

States, Irene Hall et. al., JAMA, August 6, 2008, vol. 300, No. 5

• Estimating HIV Incidence in the United States from HIV/AIDS Surveillance Data and Biomarker HIV Test Results, John Karon et al., Statistics in Medicine 2008

• Morbidity and Mortality Weekly Report, Prejean, J et. al., (www.cdc.gov/mmwr) Sept.12, 2008 vol. 57,no. 36 pp. 485-489.

Images of HIV Virus Particles:

• Russell Knightly Media

• Custom Medical Stock Photo (CMSP)

• AIDS Pathology

• Department of Microbiology University Otago, New Zealand

• Taken from www.virology.net/BIG_Virology/BVretro.html

• Cartoons– www.un.org/events/aids/2006/exhibit.asp

United Nations World AIDS Day HIV/AIDS Cartoon Exhibition Dec. 1, 2006

– www.dance4life.com/en_4life/en_cartoons Made by the World Health Organization, UN AIDS and the Office of the High Commissioner for Human Rights