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February 19, 1992, Vol 267, No. 7 >
ARTICLE | February 19, 1992

The New AIDS Case Definition: Title and subTitle BreakImplications for San Francisco FREE

Sophia W. Chang, MD, MPH; Mitchell H. Katz, MD; Sandra R. Hernandez, MD
[+] Author Affiliations

Reprint requests to San Francisco Department of Public Health, AIDS Office, 25 Van Ness Ave, Suite 500, San Francisco, CA 94102 (Dr Chang).


JAMA. 1992;267(7):973-975. doi:10.1001/jama.1992.03480070089037
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References

THE CENTERS for Disease Control (CDC) has proposed a new AIDS case definition to be effective April 1, 1992. This new definition will include those persons already meeting the 1987 AIDS definition1 and will add all adults and adolescents infected with the human immunodeficiency virus and with CD4 lymphocyte counts less than 200/μL (200×106/L).2

We review herein the importance of the CDC definition and the implications of the new definition, both for individuals and for the system of AIDS care. Our discussion will primarily focus on the effects of the 1992 definition on San Francisco, Calif. Although San Francisco has a distinctive case mix and system of AIDS care, we believe that these local effects portend changes that will be felt across the country.

Historical Perspective  The new definition represents the third revision of the CDC AIDS case definition. The list of indicator AIDS diagnoses in the original

REFERENCES

1 +
Centers for Disease Control.  Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR . 1987;;36:3S-14S.
2 +
Centers for Disease Control.  Review of draft for revision of HIV infection classification system and expansion of AIDS surveillance case definition. MMWR . 1991;;40:787.
3 +
Centers for Disease Control.  Update on acquired immune deficiency syndrome (AIDS)—United States. MMWR . 1982;;31:507-514.
4 +
Centers for Disease Control.  Revision of the case definition of acquired immunodeficiency syndrome for national reporting—United States. MMWR. 1985;;34:373-375.
5 +
Payne SF, Rutherford GW, Lemp GF, Clevenger AC.  Effect of the revised AIDS case definition on AIDS reporting in San Francisco: evidence of increased reporting in intravenous drug users. AIDS . 1990;;4:335-339.
6 +
Phillips AN, Lee CA, Elford J, et al.  Serial CD4 lymphocyte counts and development of AIDS. Lancet . 1991;;337:389-392.
7 +
Moss AR, Bacchetti P, Osmond D, et al.  Seropositivity for HIV and the development of AIDS or AIDS-related condition: three year follow-up of the San Francisco General Hospital cohort. BMJ . 1988;;296:745-750.
8 +
Lang W, Perkins H, Anderson R, et al.  Patterns of T lymphocyte changes with human immunodeficiency virus infection: from seroconversion to the development of AIDS. J Acquir Immune Defic Syndr . 1989;;2:63-69.
9 +
Centers for Disease Control.  HIV prevalence estimates and AIDS case projections for the United States: report based upon a workshop. MMWR . 1990;;39:1-31.
10 +
Brookmeyer R, Liao J.  Statistical modelling of the AIDS epidemic for forecasting health care needs. Biometrics . 1990;;46:1151-1163.
11 +
Brundage JF, McNeil JG, Miller RN, et al.  The current distribution of CD4+ T-lymphocyte counts among adults in the United States with human immunodeficiency virus infections: estimates based on the experience of the U.S. army. J Acquir Immune Defic Syndr . 1990;;3:92-94.
12 +
Brookmeyer R.  Reconstruction and future trends of the AIDS epidemic in the United States. Science . 1991;;253:37-42.
13 +
Sheppard HW, Winkelstein W, Osmond D, Moss AR.  Effect of new AIDS case definition on numbers of cases among homosexual and bisexual men in San Francisco. JAMA . 1991;;266:2221.
14 +
Taylor J, Fahey J, Detels R, Giorgi J.  CD4 percentage, CD4 number, and CD4:CD8 ratio in HIV infection: which to choose and how to use. J Acquir Immune Defic Syndr . 1989;;2:114-124.
15 +
McCarthy RC, Fetterhoff TJ.  Issues for quality assurance in clinical flow cytometry. Arch Pathol Lab Med . 1989;;113:658-666.
16 +
Malone JL, Simms TE, Gray GC, et al.  Sources of variability in repeated T-helper lymphocyte counts from human immunodeficiency virus type 1-infected patients: total lymphocyte count fluctuations and diurnal cycle are important. J Acquir Immune Defic Syndr . 1990;;3:144-151.
17 +
Steinberg C, Cunningham-Rundles S.  Standardization of T-cell subset enumerations. JAMA . 1989;;262:1526.
18 +
Social Security Administration.  Policy interpretation ruling Titles II and XVI: evaluation of human immunodeficiency virus infection. Federal Register . (December 17) , 1991;;56:65498-65505.
19 +
Hutchinson CM, Wilson C, Reichart CA, et al.  CD4 lymphocyte concentrations in patients with newly identified HIV infection attending STD clinics: potential impact on publicly funded health care resources. JAMA . 1991;;266:253-256.
20 +
Arno PS.  The nonprofit sector's response to the AIDS epidemic: community-based services in San Francisco. Am J Public Health . 1986;;76:1325-1330.
21 +
Ball J, Turner B. AIDS in U.S. Hospitals, 1986-87: A National Perspective . Rockville, Md: Agency for Health Care Policy and Research; 1991;;15:1-15. Public Health Service publication 91-0015.
22 +
Health and Public Policy Committee, American College of Physicians.  Financing the care of patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med . 1988;;108:470-473.
23 +
Hellinger FJ.  Forecasting the medical care costs of the HIV epidemic, 1991-1994. Inquiry . 1991;;28:213-225.
24 +
Green J, Arno PS.  The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care. JAMA . 1990;;264:1261-1266.
25 +
Valdiserri RO, Cross GD, Gerber AR, Schwartz RE, Hearn TL.  Capacity of US labs to provide TLI in support of early HIV-1 intervention. Am J Public Health . 1991;;81:491-494.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Centers for Disease Control.  Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR . 1987;;36:3S-14S.
2 +
Centers for Disease Control.  Review of draft for revision of HIV infection classification system and expansion of AIDS surveillance case definition. MMWR . 1991;;40:787.
3 +
Centers for Disease Control.  Update on acquired immune deficiency syndrome (AIDS)—United States. MMWR . 1982;;31:507-514.
4 +
Centers for Disease Control.  Revision of the case definition of acquired immunodeficiency syndrome for national reporting—United States. MMWR. 1985;;34:373-375.
5 +
Payne SF, Rutherford GW, Lemp GF, Clevenger AC.  Effect of the revised AIDS case definition on AIDS reporting in San Francisco: evidence of increased reporting in intravenous drug users. AIDS . 1990;;4:335-339.
6 +
Phillips AN, Lee CA, Elford J, et al.  Serial CD4 lymphocyte counts and development of AIDS. Lancet . 1991;;337:389-392.
7 +
Moss AR, Bacchetti P, Osmond D, et al.  Seropositivity for HIV and the development of AIDS or AIDS-related condition: three year follow-up of the San Francisco General Hospital cohort. BMJ . 1988;;296:745-750.
8 +
Lang W, Perkins H, Anderson R, et al.  Patterns of T lymphocyte changes with human immunodeficiency virus infection: from seroconversion to the development of AIDS. J Acquir Immune Defic Syndr . 1989;;2:63-69.
9 +
Centers for Disease Control.  HIV prevalence estimates and AIDS case projections for the United States: report based upon a workshop. MMWR . 1990;;39:1-31.
10 +
Brookmeyer R, Liao J.  Statistical modelling of the AIDS epidemic for forecasting health care needs. Biometrics . 1990;;46:1151-1163.
11 +
Brundage JF, McNeil JG, Miller RN, et al.  The current distribution of CD4+ T-lymphocyte counts among adults in the United States with human immunodeficiency virus infections: estimates based on the experience of the U.S. army. J Acquir Immune Defic Syndr . 1990;;3:92-94.
12 +
Brookmeyer R.  Reconstruction and future trends of the AIDS epidemic in the United States. Science . 1991;;253:37-42.
13 +
Sheppard HW, Winkelstein W, Osmond D, Moss AR.  Effect of new AIDS case definition on numbers of cases among homosexual and bisexual men in San Francisco. JAMA . 1991;;266:2221.
14 +
Taylor J, Fahey J, Detels R, Giorgi J.  CD4 percentage, CD4 number, and CD4:CD8 ratio in HIV infection: which to choose and how to use. J Acquir Immune Defic Syndr . 1989;;2:114-124.
15 +
McCarthy RC, Fetterhoff TJ.  Issues for quality assurance in clinical flow cytometry. Arch Pathol Lab Med . 1989;;113:658-666.
16 +
Malone JL, Simms TE, Gray GC, et al.  Sources of variability in repeated T-helper lymphocyte counts from human immunodeficiency virus type 1-infected patients: total lymphocyte count fluctuations and diurnal cycle are important. J Acquir Immune Defic Syndr . 1990;;3:144-151.
17 +
Steinberg C, Cunningham-Rundles S.  Standardization of T-cell subset enumerations. JAMA . 1989;;262:1526.
18 +
Social Security Administration.  Policy interpretation ruling Titles II and XVI: evaluation of human immunodeficiency virus infection. Federal Register . (December 17) , 1991;;56:65498-65505.
19 +
Hutchinson CM, Wilson C, Reichart CA, et al.  CD4 lymphocyte concentrations in patients with newly identified HIV infection attending STD clinics: potential impact on publicly funded health care resources. JAMA . 1991;;266:253-256.
20 +
Arno PS.  The nonprofit sector's response to the AIDS epidemic: community-based services in San Francisco. Am J Public Health . 1986;;76:1325-1330.
21 +
Ball J, Turner B. AIDS in U.S. Hospitals, 1986-87: A National Perspective . Rockville, Md: Agency for Health Care Policy and Research; 1991;;15:1-15. Public Health Service publication 91-0015.
22 +
Health and Public Policy Committee, American College of Physicians.  Financing the care of patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med . 1988;;108:470-473.
23 +
Hellinger FJ.  Forecasting the medical care costs of the HIV epidemic, 1991-1994. Inquiry . 1991;;28:213-225.
24 +
Green J, Arno PS.  The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care. JAMA . 1990;;264:1261-1266.
25 +
Valdiserri RO, Cross GD, Gerber AR, Schwartz RE, Hearn TL.  Capacity of US labs to provide TLI in support of early HIV-1 intervention. Am J Public Health . 1991;;81:491-494.

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