HIV/AIDS EPIDEMIOLOGY. Rachel Rivera, MD Assistant Professor Infectious Diseases UT Southwestern Medical Center November 14, PDF Free Download

HIV/AIDS EPIDEMIOLOGY Rachel Rivera, MD Assistant Professor Infectious Diseases UT Southwestern Medical Center November 14, 2014

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RACHEL RIVERA, MD Dr. Rivera attended medical school at UT Health Science Center in San Antonio, completed residency in Internal Medicine at UT Southwestern, Infectious Diseases fellowship at UT Health Science Center San Antonio. Dr. Rivera is an assistant professor in Infectious Diseases at UT Southwestern.

HIV/AIDS EPIDEMIOLOGY Rachel Rivera, MD Assistant Professor Infectious Diseases UT Southwestern Medical Center November 14, 2014

NO DISCLOSURES

OBJECTIVES General Review of the history of the AIDS epidemic Discuss the scope of the AIDS epidemic as it relates to age, gender, and ethnicity Understand the effect AIDS has had on rural and urban communities

AIDS IN THE UNITED STATES June 1981 CDC reports 5 cases of Pneumocystis carinii pneumonia in men who have sex with men (MSM) in Los Angeles, California Also found to have thrush, CMV viremia/viruria, leukopenia and transaminitis Disease associated with sexual contact Disease manifestations associated with cellular-immune dysfunction MMWR JUNE 5, 1981 / 30(21);1-3

AIDS EPIDEMIOLOGY THEN AND NOW HIV/AIDS cases in the US have been monitored by the CDC since 1981 Pre-HAART era: 1981-1995 Early HAART era: 1996-2000 HAART era: 2001-2005 Post HAART era: 2005-present MMWR JUNE 2, 2006 / 55(21);589-592

BEGINNING OF THE AIDS EPIDEMIC 78,000 cases were reported between 1981 and 1992 Initially, cases were mostly white MSM Women, IVDU and minorities have been disproportionately affected since the 1990 s MMWR JUNE 2, 2006 / 55(21);589-592

HISTORY OF AIDS EPIDEMIC

DIAGNOSES OF HIV INFECTION AMONG ADULTS AND ADOLESCENTS, BY TRANSMISSION CATEGORY, 2012 UNITED STATES AND 6 DEPENDENT AREAS N = 48,651 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

DIAGNOSES OF HIV INFECTION AMONG ADULTS AND ADOLESCENTS, BY SEX AND RACE/ETHNICITY, 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race.

DIAGNOSES OF HIV INFECTION AMONG ADULTS AND ADOLESCENTS, BY AGE AT DIAGNOSIS, 2012 UNITED STATES N = 47,746 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

DIAGNOSES OF HIV INFECTION AMONG ADULTS AND ADOLESCENTS, BY RACE/ETHNICITY, 2008 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race.

DIAGNOSED HIV INFECTIONS ATTRIBUTED TO MALE-TO-MALE SEXUAL CONTACT AND INJECTION DRUG USE, BY RACE/ETHNICITY, 2012 UNITED STATES AND 6 DEPENDENT AREAS Race/ethnicity No. % American Indian/Alaska Native 19 1.4 Asian 16 1.2 Black/African American 352 25.6 Hispanic/Latino a 300 21.8 Native Hawaiian/other Pacific Islander 7 0.5 White 638 46.4 Multiple races 43 3.1 Total b 1,375 100.0 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Hispanics/Latinos can be of any race. b Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

DIAGNOSED HIV INFECTIONS ATTRIBUTED TO HETEROSEXUAL CONTACT A, BY SEX AND RACE/ETHNICITY, 2012 UNITED STATES AND 6 DEPENDENT AREAS Males Females Total Race/ethnicity No. % No. % No. % American Indian/Alaska Native 16 0.4 32 0.4 48 0.4 Asian 48 1.1 135 1.6 183 1.5 Black/African American 2,745 65.7 5,542 66.0 8,288 65.9 Hispanic/Latino b 801 19.2 1,315 15.7 2,117 16.8 Native Hawaiian/other Pacific Islander 2 0.0 9 0.1 10 0.1 White 508 12.2 1,225 14.6 1,733 13.8 Multiple races 57 1.4 144 1.7 201 1.6 Total c 4,177 100.0 8,402 100.0 12,580 100.0 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Hispanics/Latinos can be of any race. c Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

Diagnosed HIV Infections Attributed to Injection Drug Use, by Sex and Race/Ethnicity, 2012 United States and 6 Dependent Areas Males Females Total Race/ethnicity No. % No. % No. % American Indian/Alaska Native 15 0.7 13 1.0 28 0.8 Asian 25 1.2 10 0.8 35 1.0 Black/African American 1,012 47.3 671 51.0 1,683 48.7 Hispanic/Latino a 649 30.3 196 14.9 846 24.5 Native Hawaiian/other Pacific Islander 1 0.0 2 0.1 3 0.1 White 407 19.0 386 29.3 793 22.9 Multiple races 30 1.4 39 3.0 69 2.0 Total b 2,139 100.0 1,317 100.0 3,456 100.0 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Hispanics/Latinos can be of any race. b Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

Diagnoses of HIV Infection among Adult and Adolescent Females, by Race/Ethnicity, 2012 United States Race/ethnicity No. Rate American Indian/Alaska Native 45 4.7 Asian 146 2.1 Black/African American 6,293 37.8 Hispanic/Latino a 1,289 6.5 Native Hawaiian/other Pacific Islander 11 5.1 White 1,620 1.9 Multiple races 184 9.3 Total b 9,586 7.2 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. a Hispanics/Latinos can be of any race. b Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

SUMMARY OF HIV STATISTICS: 2012 Risk factor with the highest percentage of HIV infections as of 2012 MSM Race with the largest percentage of HIV diagnoses each year from 2008-2012 African-Americans Age with the highest rate of infection 25-34 year olds In heterosexuals, the highest percentage of HIV diagnoses in males and females was in African-Americans In IDU, about half of HIV infections were in African-Americans, about a third were Hispanic and about 20% were white CDC.GOV

RATES OF STAGE 3 (AIDS) CLASSIFICATIONS AMONG PERSONS WITH HIV INFECTION, 2012 UNITED STATES AND 6 DEPENDENT AREAS N = 28,319 TOTAL RATE = 8.9 Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

STAGE 3 (AIDS) CLASSIFICATIONS AND DEATHS OF PERSONS WITH HIV INFECTION EVER CLASSIFIED AS STAGE 3 (AIDS), AMONG ADULTS AND ADOLESCENTS, 1985 2011 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. Deaths of persons with HIV infection, stage 3 (AIDS) may be due to any cause.

STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY TRANSMISSION CATEGORY AND YEAR OF DIAGNOSIS, 1985 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

PERCENTAGES OF STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY TRANSMISSION CATEGORY AND YEAR OF DIAGNOSIS, 1985 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY RACE/ETHNICITY AND YEAR OF DIAGNOSIS, 1985 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race. b Includes Asian/Pacific Islander legacy cases.

PERCENTAGES OF STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY RACE/ETHNICITY AND YEAR OF DIAGNOSIS, 1985 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race. b Includes Asian/Pacific Islander legacy cases.

STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY SEX AND TRANSMISSION CATEGORY, 2012 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete reporting. a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection. b Includes hemophilia, blood transfusion, perinatal exposure, and risk factor not reported or not identified.

ADULTS AND ADOLESCENTS LIVING WITH DIAGNOSED HIV INFECTION EVER CLASSIFIED AS STAGE 3 (AIDS), BY SEX, 1993 2011 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

PERSONS LIVING WITH DIAGNOSED HIV INFECTION EVER CLASSIFIED AS STAGE 3 (AIDS), BY RACE/ETHNICITY, 1993 2011 UNITED STATES AND 6 DEPENDENT AREAS Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. a Hispanics/Latinos can be of any race. b Includes Asian/Pacific Islander legacy cases.

STAGE 3 (AIDS) CLASSIFICATIONS AMONG ADULTS AND ADOLESCENTS WITH HIV INFECTION, BY RACE/ETHNICITY, 2012 UNITED STATES Race/ethnicity No. Rate American Indian/Alaska Native 114 6.1 Asian a 418 3.2 Black/African American 14,094 44.8 Hispanic/Latino b 5,418 13.5 Native Hawaiian/other Pacific Islander 32 7.7 White 6,932 4.1 Multiple races 910 23.8 Total c 27,918 10.7 Note. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting. Rates are per 100,000 population. a Includes Asian/Pacific Islander legacy cases. b Hispanics/Latinos can be of any race. c Because column totals for estimated numbers were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.

SUMMARY OF AIDS STATISTICS-2012 Highest rate of AIDS cases is in the District of Columbia Number of AIDS diagnoses and deaths has been declining since 1993 MSM represent the highest number of AIDS cases each year since 1985 Number of AIDS cases in heterosexuals continues to increase Number of AIDS cases in IDU continues to decrease CDC.GOV

SUMMARY OF AIDS STATISTICS-2012 Number of AIDS diagnoses in African-Americans surpassed all other races in 1994 Percentage of AIDS diagnoses is increasing in MSM and heterosexuals Majority of AIDS diagnoses in females is in heterosexual contact followed by IDU Just over 500,000 people were living with AIDS at the end of 2011 Majority of people living with AIDS are African-Americans African-Americans have the highest rate (44.8 per 100,000) of AIDS diagnoses CDC.GOV

HIV DIAGNOSES IN TEXAS 2011: Texas ranked 3 rd in number of new diagnoses in the US 5044 new diagnoses in TX 49,273 new diagnoses in the US MSM (66.6%), African Americans (39.8%) and Latinos (33.2%) represented majority of new cases CDC.GOV

RATES OF DIAGNOSES OF HIV INFECTION AMONG ADULTS AND ADOLESCENTS, 2012 UNITED STATES AND 6 DEPENDENT AREAS N = 48,651 TOTAL RATE = 18.4 Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have been statistically adjusted to account for reporting delays, but not for incomplete reporting.

HIV DIAGNOSES IN TEXAS 2012 Males 36.4 per 100,000 (nationally 29.9) Females 8.5 per 100,000 (nationally 7.2) 25-34 year olds comprise majority of new diagnoses 39.4 per 100,000 in TX 33.0 per 100,000 nationally African-Americans represent majority of new diagnoses 73.2 per 100,000 in TX 71.2 per 100,000 nationally HTTP://WWW.CDC.GOV/NCHHSTP/ATLAS/

HIV/AIDS IN GRAYSON COUNTY 7.6 cases per 100,000 in 2012 CDC estimates that 25% of any given population is unaware that they are HIV positive HTTP://WWW.CDC.GOV/NCHHSTP/ATLAS/

STATE HIV PREVENTION PROGRESS REPORT (SPR) Division of HIV/AIDS Prevention, CDC Summarizes state level data for overall prevention and care of people living with HIV HIV testing Late stage diagnosis (AIDS) Linkage to care Retention in care Viral suppression Death rates Limited to race/ethnicity, does not include age or transmission risk HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

SPR 2015 GOALS HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

SPR GOALS 2015 HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

HIV TESTING Southern states had a higher percentage increase in HIV testing compared to other states 14 states and the District of Columbia met the 2015 goal of increasing by 4% the number of people tested for HIV 33 states were below the national percentage (42.5%) HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

DEATH RATES Higher in southern states compared to other states Death rate is higher than the national rate (24 per 1,000) in 27 states In 2010, about 21,000 diagnosed with HIV died HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

HTTP://WWW.CDC.GOV/HIV/PDF/POLICIES/ST ATEPROGRESSREPORT2014.PDF

ANTIRETROVIRAL THERAPY HTTP://WWW.AIDS.GOV/FEDERAL- RESOURCES/POLICIES/CARE-CONTINUUM/

FUTURE DIRECTIONS In Texas, there is room for improvement in the following areas: Increasing HIV testing Monitoring and reporting linkage to care Monitoring and reporting retention in care Reducing race related health disparities

Q&A If you have not already done so, please type your questions for the speaker in the chat box entitled, Questions for the Speaker to the right. Questions will be answered as time allows. 65

UPCOMING PRESENTATION: Cultural Competency and the HIV Provider: Reaching the African American Female Patient Presented by Dr. Ohagi Thursday November 20 th at 12:00 pm CT Routine HIV Testing Presented by Dr. Rivera from UTSW Friday November 21 st at 12:00 pm CT

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HIV/AIDS EPIDEMIOLOGY. Rachel Rivera, MD Assistant Professor Infectious Diseases UT Southwestern Medical Center November 14, 2014