Pediatric AIDS. Through December 1999, 8,718 case of AIDS among children younger than 13 years of age have been reported in the United States. Of those, 5,084 have died. Pediatric AIDS cases represent 1.2 percent of all the cumulative cases (733,374) reported to the Centers for Disease Control and Prevention (CDC). The vast majority of children with AIDS (91 percent) resulted from transmission of HIV before or during birth, or what is known as perinatal transmission.
The steep decline in perinatally acquired AIDS (Figure HC 2.11A) has been one of the dramatic changes of the 1990s. The number of perinatally acquired AIDS cases peaked in 1992 and has decreased 75 percent in recent years. Studies and surveillance data suggest that the implementation of Public Health Service guidelines for universal counseling and voluntary HIV testing of pregnant women and the use of zidovudine by pregnant women and administered to newborn infants account primarily for the decline. The rate of perinatal transmission is expected to continue to decline as a result of more aggressive courses of treatment (e.g., combination therapy) and more use of obstetric procedures, such as elective cesarean section, that reduce transmission.
Differences by Race and Hispanic Origin. Decreases in perinatally acquired AIDS have occurred in all racial and ethnic groups. However, in 1999, the highest rates of AIDS continue to be reported among children who are black, non- Hispanic, and Hispanics (Figure HC2.11B). The rate of AIDS among black children in 1999, 2.3 per 100,000 children, was 23 times higher than among white children (0.1 per 100,000) and nearly four times higher than among Hispanic children (0.6 per 100,000). Because the majority of pediatric cases of AIDS are attributed to perinatal HIV transmission, these rates also reflect the disproportionate racial/ethnic distribution of HIV and AIDS among black and Hispanic women.
Adolescent HIV/AIDS. As of the end of 1999, 3,725 adolescents (ages 13-19) have been reported with AIDS. Adolescent AIDS cases represent less than 1 percent of all cumulative cases (733,374) reported to the CDC. The number of adolescents reported with AIDS peaked in 1993 when the surveillance case definition was changed (Figure HC2.11C). In the earlier years, the vast majority of reported cases in adolescents were among males; however, the ratio of male to female cases has decreased over time. In 1999, 312 persons, 13-19 years old, were reported with AIDS; more females (180) than males (132) were reported with AIDS in this age group, in part, because the proportion of male cases who acquired HIV through receipt of blood products has diminished.
Data from HIV infection case surveillance present a more current view of the HIV/AIDS epidemic than AIDS case surveillance data alone. Currently, 31 states and the Virgin Islands conducted name-based confidential HIV infection surveillance of adults and adolescents. In 1999, these 32 areas reported 3,209 cases of HIV infection in adolescents and young adults ages 13-24, compared to 1,813 reported with AIDS. The HIV data are underestimates of the population of infected adolescents, as some states do not report HIVinfected persons to the CDC, and only persons who have been tested are reported. However, the number of adolescents reported with HIV is greater than those reported with AIDS because of the long period of time between infection and development of disease. Young adults with AIDS probably became infected as adolescents but did not develop AIDS or get reported as having AIDS until they were adults. This indicates the importance of targeting HIV prevention messages to youth even though the total numbers of AIDS cases reported in this age group is relatively small.
Black and Hispanic adolescents have been disproportionately affected by the HIV/AIDS epidemic. Although only 15 percent of the adolescent population in the United States is black, 60 percent of AIDS cases reported in 1999 among 13- to 19-year-olds were black. Hispanics compromise 14 percent of the population, 20 percent of all reported AIDS cases and 24 percent of reported adolescent AIDS cases in 1999.46 These patterns are likely to continue since HIV infection also disproportionately affects young black and Hispanic persons.
Figure HC 2.11.A Reported perinatally acquired AIDS cases among children under age 13 in the United States: 1985–1998
Note: Data are adjusted for reporting delays and unreported risk.
Source: Pediatric AIDS Surveillance, L262 slide series (through 1997). Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. The slide series is available online at: http://www.cdc.gov/nchstp/hiv_aids/graphics/pediatri.htm.
Figure HC 2.11.B Reported AIDS rate (per 100,000) among children under age 13 in the United States, by race and Hispanic origin:a 1999
a Persons of Hispanic origin may be of any race
Source: Pediatric AIDS Surveillance, L262 slide series (through 1997). Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. The slide series is available online at: http://www.cdc.gov/hiv
Figure HC 2.11.C AIDS cases in adolescents ages 13 through 19, by gender in the United States: 1985–1999
Source: Adolescent AIDS Surveillance, L265 slide series (through 1998). Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. The slide series is available online at: http://www.cdc.gov/hiv
46 Pediatric AIDS Surveillance, L262 slide series (through 1997). Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. The slide series is available online at: http://www.cdc.gov/nchstp/hiv_aids/graphics/pediatri.htm.b
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