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New CDC Reports Shed Light on HIV Incidence and Testing

Washington Editor

WASHINGTON — About 250,000 people in the U.S. are unaware that they are infected with the HIV virus, the Centers for Disease Control and Prevention reported Thursday.

HIV testing rates among U.S. adults have remained flat in the past several years, with only about 40 percent of adults reporting ever being tested for the infection, the agency said.

Federal health officials also reported that a new analysis, which was published in a special issue of the Journal of the American Medical Association, found there were 56,300 new HIV infections in 2006 - a 40 percent increase of the 40,000 standard figure the CDC had been professing in recent years.

The new data suggested that after several years of steady increases in overall testing associated with targeted strategies, HIV testing stalled in the mid- to late-90s, while the rates among adults remained nearly flat from 2001 to 2006. While the data indicated that some U.S. adults were being tested repeatedly, the exact number is unknown, the CDC reported in its Morbidity and Mortality Weekly Report.

Among those surveyed for the CDC report, 23 percent with an HIV risk factor - persons who have hemophilia and have received a clotting factor, a man who has sex with other men, needle users of street drugs or someone who has had sex with a person who is infected with or at high risk for HIV infection - said they had been tested in the past year, compared with 10 percent of those who said they did not have an HIV risk factor.

In 2006, greater percentages of U.S. residents 18 to 34, women and residents of the southern states reported being tested for HIV during the preceding 12 months than did those ages 35 to 64 years, men and residents outside of the South, officials said.

Slightly more than 60 percent of pregnant women who were surveyed said they had been tested within the past year compared with 12.8 percent of those who were not pregnant, the CDC reported, noting that that percentage is considerably lower than rates of screening reported for other infectious diseases.

One possible reason for the relatively lower rate of HIV testing among pregnant women, health officials contended, is that unlike others infectious diseases, such as hepatitis B, rubella and syphilis, HIV is not currently included by the American Medical Association as one of the defined components of the obstetric panel Common Procedural Terminology code, which includes blood count, HBsAg, rubella antibody, syphilis screen and blood type and group.

The CDC has recommended routine prenatal HIV screening since 1995. Federal health officials called for expanded screening in health care settings and other strategies to boost testing. "The findings help confirm that new strategies are warranted to increase HIV testing, particularly among persons who are disproportionately affected by HIV infection," the CDC said.

The new federal figures on HIV, said Michael Weinstein, president of the nonprofit AIDS Healthcare Foundation, are a "scathing indictment of how profoundly U.S. and CDC HIV prevention efforts have failed."

"There is absolutely no good news here," he said, noting that his group has been calling for the release of the incidence data since last October.

"Without an accurate picture of the epidemic, vastly underestimated for the past 10 years, we have missed countless opportunities to intervene with effective public health strategies," Weinstein said in a statement.

He called for Congress to appropriate $200 million for HIV testing to be available for up to 10 million U.S. residents over the next three years. "Massive scale-up of HIV testing is the only way to bring down these appalling numbers," he said. "Identifying all those who are infected and linking them to treatment is the only way to break the chain of new infections and begin to address the nation's runaway epidemic."

Rep. Henry Waxman (D-Calif.), chairman of the House Oversight and Government Reform Committee, said Friday he plans to hold a hearing when Congress reconvenes after the August break about the CDC's newly reported incidence numbers.

In a letter to CDC Director Julie Gerberding, Waxman requested a detailed "professional judgment budget" for HIV prevention for the five years beginning with fiscal 2009, which he said should be prepared independently of the Department of Health and Human Services and the White House Office of Management and Budget.

The HIV budget, Waxman told Gerberding, "should reflect your best professional judgment on what resources CDC would need in order to perform its key HIV prevention functions most effectively."

Waxman also called for a breakdown of the new HIV incidence estimate that "stratifies data within each transmission category by both race/ethnicity and age, to the extent the data permit."

He gave Gerberding until Sept. 3 to respond.

Epilepsy Patients Going Untreated

About one-third of adults diagnosed with epilepsy, which affects about 2.7 million people in the U.S., are insufficiently treated for the condition, the CDC said in a new report. The agency's study, which was published in the CDC's Morbidity and Mortality Weekly Report, examined the prevalence of epilepsy or seizure disorder in 19 states. The study's data were collected from more than 120,000 adults. The study found that 44 percent of adults with active epilepsy reported having recent seizures, with 65 percent of those reporting having had more than one seizure in the past three months.

"Despite having recent seizures, more than one out of three adults reported not seeing a neurologist or epilepsy specialist in the past year," said study co-author David Thurman, a neurologist in the CDC's Division of Adult and Community Health. "These findings suggest that adults with uncontrolled seizures may not be receiving the optimal medical treatment they need and may face substantial impairments in their daily activities."

Inadequate medical treatment for epilepsy greatly increases a person's risk for subsequent seizures, disability, injuries sustained during a seizure and death, the CDC warned. However, health officials noted that many people with epilepsy lead normal lives.

The report found adults with epilepsy were more likely to be unemployed, face limitations in their normal activities such as socializing with friends, and experience other health risks such as cigarette smoking and physical inactivity.

Published: August 11, 2008