Figures on H.I.V. rate expected to rise

Source: The New York Times

By GARDINER HARRIS
Published: December 2, 2007

WASHINGTON, Dec. 1 — More people in the United States are infected each year with the AIDS virus than previously thought, according to federal health officials, in a finding that could affect the debate over how much money should be spent on prevention efforts. No one is yet sure whether more people have actually been infected in recent years or the figures, still undergoing peer review, are simply a better estimate than the old ones.

For 14 years, the Centers for Disease Control and Prevention used informal methods to estimate that about 40,000 people annually in the United States are newly infected with H.I.V. In recent years, federal officials have worked to set up a more accurate assessment technique. The numbers from the new system are now in, although the agency has not released them. The Washington Blade, a gay newspaper, reported on Nov. 14 that the new estimates showed infection rates were 50 percent higher than previously believed, with 58,000 to 63,000 infected in the most recent 12-month period. The Washington Post and The Wall Street Journal had similar reports on Saturday.

“We currently have a paper going through a scientific review process,” Tom Skinner, a C.D.C. spokesman, said Saturday, “and until that process is complete, we’re not in a position to say one way or another whether the numbers will actually be up from current estimates.”

A federal official who would not speak for attribution about the new numbers because of the review process said they were indeed higher than the old estimate, but not by as much as The Blade and The Post reported. It has been clear for at least a year that the old estimate would have to be revised upward, said David R. Holtgrave of Johns Hopkins University, a former director of one of the C.D.C.’s principal AIDS prevention programs. From 2001 to 2005, more than 186,000 people in 33 states received diagnoses of H.I.V. or AIDS, according to figures. That amounts to more than 37,000 new cases each year from just two-thirds of the country.

“With just a little simple math, you get more than 40,000 new cases,” Dr. Holtgrave said.

Whether the number of infections is higher than previously believed and whether infection rates are rising are both politically charged issues. President Bush has increased financing for AIDS treatment and prevention programs abroad, but spending for domestic prevention efforts dropped 19 percent in inflation-adjusted terms from 2002 to 2007.

Julie Davids, executive director of the Community H.I.V./AIDS Mobilization Project, a national advocacy group, said it planned to protest Tuesday in front of the C.D.C. headquarters in Atlanta to demand that the agency release the new figures and step up prevention efforts. “We don’t know whether infection rates are rising or they’ve just been higher than we thought,” Ms. Davids said. “But either way, this shows that prevention efforts are insufficient.”

Doctors and states are required to report cases of full-blown AIDS, but only some states report positive results on tests for H.I.V. infection to the agency. It takes years for someone who is infected to develop symptoms; many people have been infected for years before they are tested. Under the C.D.C.’s new surveillance system, 19 states and cities are performing two different blood tests of H.I.V. antibodies — the first indication of an infection. One test is highly sensitive and is able to spot an infection even in its earliest months. The other test is cruder, and patients must nurse an infection for many months before it can be identified with this test. When a blood sample receives a positive result on the first test and a negative result on the second, officials have decided that this person was probably infected recently. By adding up these mixed results and projecting them across the country, the agency is able to come up with an estimate for new infections. The agency sent out a letter to scientists on Nov. 26 describing the new system and urging patience as the numbers are reviewed.

Donald G. McNeil Jr. contributed reporting from New York.