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tnnqrus nt tlu Alnttnn Bums Orrlca or Tsc
042
NEW AIDS DEFINITION WILL SIGNIFICANTLY INCREASE
NUMBER
OF CASES REPORTED
TO ADEOUATELV CAPTURE
BUT MAY STILL FAIL
SDME MAJOR RISK GROUPS
A new delinrtion of acouired lrnrnunodeliciency syndrome (AIDS), expected In 1992 from the
Centers lor Disease Corttrol (CDO),
would Increase the number of cases reported but could stlll leave some
major rlsk groups underrepresented, says the congressional Olflce of Technology Assessment (OTAI In a
The AIDS case tlcnnrtlon, first devetoped by the CDC
primary
In t9&2 and revised In 1955
public health surveillance tool used to determine the scope ol the AIDS epidetttlc
denning conditions inthe current delrnltton, rncludlng
pneumonia,
and l9B7,
is the
The 23 AIDSV
Kaposrs sarcoma and Prreumocystrs carinii
mark the linal stage In the progression of HIV inlection.
Thess AID$delinIng condltlons are
requirement lor a posnlve HIV antibody test), are consldcted to have AIDS
Sorne crltIcs have Iaulted the current dellnitlun ol AIDS for not including
some severe
untleresuntatron ofthe impact of the epidemic on these populations and hindering their access to Federal
The CDC's proposed AIDS case dellnitlon wlll Include all Hlvinlected
of more of tive 23 AIDS·delInIng conditions included In the current dennrtlon,
will be expanded to include all
cubic
mtlllmeter
HIV»positIve persons with CD4
of blood.
The CD-4*
proposed expansion inthe AIDS case tleltnition will
States by 52
lymphocyte 030 counts below 200 cells per
lymphocyte count is a laboratory measure of the progression
scvnral advantages for AIDS surveillance, says OTA
to
persons who have any one
In addition. the case definition
AIDS surveillance data will better tellect the extent ol
increase the total number of AIDS cases In the United
percerttr and Slate and Iocal health depanments estimate that the increase will
t35 percent
AIDS case reporting may be slmplllied
physicians to monitor the CD4`
be facilitated by enlisting
because It ls a standard ol clinlcal
lymphocyte counts of thelr HlV
clinical laboratories that perform ODP
OTA notes that despne its advantages, the CD4'
surveillance tool
024lniected patlenls
testlng to help
range lront J6
care lor
AIDS survelllance may
dentlty potential AIDS
lymphocyte count is not a perfect AIDS
Because ntany HlIIrInfected persons wltlt a CD4'
lymphocyte count below 200
cells/mm3 will be syrnptomrfree and may not seek health care, the completeness of reporting may be
dlltlcultto assess
Furthermore. populations with better access to testing will
Identrried AIDS cases
HIV
024infected women and Inteetlon drug
ol otherAIDS risI< groups, ana may have less access to CD4'
testing
The proposed detinition will,
however, capture an Increasing proportion ol proloundly lmmunosuppressed
Injection drug users who do not have AlDSrdelining
be ovevrepresented among
users are on average poorer than members
conditions
HIV·Infectedwomen and
ln ma ms: ynars altar the pmposm msn uslinniun
me CDC will
is lmplsmsmsd. spldsmlclcglsu nnlldpam than
mss hs abimyw Mlow lrnnds mms kncbdancs cl AIDS.
(mcse Hlwniecisd persons who nurrnnuy have a CD4'
Huwuvnr, anu all prevalent cans
lymphocyte count haicw 2¤¤ news/mm] bm whn
Wm prupusm chang: m mu AIDS case delmmon raises privacy concnms becausn mms w¤\l bs an
depanmsms.
\n planning to Implementthe new dshrmlon,
States should reassess cunent iaws am
operational procedures mst protect me uunnuanualny no CD4'
ms: results
In addhiun. several Suxes have
proposed xc have dwmcal hburarsvnas vnpcnmz namas ci persons wnh Iuw CDV
State and local heahh departments
CD4'
lymphnoyn count mn
lymphocyte nunmsm
The State and local hwlh departments mn msn aumwrup wnh lhs
be daprsssod \n utherdlsoasas. soma persons reported as llkuy AIDS msu
Thr CDC msn dstlrmlnn hu also been used asa cllnlcal duflrmlun
pmmculs, and In me alfocatlun ul Federal funds undnrms Ryan Whlu
by physlclans,
In rssanrnh
Oompmhnnstvs Resources
aware that more ws a broader spectrum or Hlvassocwalnd cundnions mnn \s mulndnd
in me AIDS
quafly Qnrinnding under ma Ryan Whks Cnmpmhenslva Resources Emergency Act ot l990, and me
mcrsasu in AIDS cases may allsrrhe dlstrlbmlcn nl Iunds among rnaunpnlnan
addvunn,
areas and States,
ln
mum cnies and States ww bs sugwuhaIc1|unds1rcmkheAID5 Huuslnq Oppnnunny Act :1+ \990,
although me U.$
Department ul
Housing and Urban Dnvelupmsnt has yn to dlsmnma Vunds under ma
The CDC dn¤nArl¤n has been used as a measure cl dlsahnlhy in benem prugramsadrmnistemd by
Una Soclm Se
042:urnyA¤m¤nis\rz\inn (SSA) In mu Department ¤1 Health and Human Services
bewng wrongly denied dlsabwlny bermhs because muh
dehnnicn,
The uso mths
wllrwsses were nm included nn mn AIDS case
Fav many pecpde, slignbimy mr Social Sscumy disablny bensms also snahluslhnmm nblaln
Medkcald, a Fndsrm/Slalsriundnd medical msuruncs program
disability henems are awarded Chess henefns.
The Social Securi|yAdminisxrzu0n has
Nnnarhdass, ma numnmus examplns cl H\V·inle¤1m1
The SSA recently issued requluxions suhstamially rwlslnq ns dfsnlulhy cmena Qnrail HW-inlsctsd
persons, inducing
persons wnh AIDS.
AIDS advocates as bam; mu
The wucriteria, which have ham cmlclzod
by medical groups and
rutrinivs. demcnsxnuexhamuu dnnqa In mn CDC definnlnn ci AIDS w\ll nm
Copies ui the Gibpage backgmund paper The CDC': Casa Dehniricn nIAI¤S·
Proposed Ruvlslcns Var cungressmnal
use can be urdsred bum
D.C
20402-9325;
phnne
use an nvawabls hy rzlling A-9241
me Supennmndent ul Documents, U
(2112)
Tmruzas.
S
Implications ol me
Ocprnslur nuncnngrssslunsl
Gcvemmem Pnnung Omoo, Washingmn.
Th: GPO order numhu Is B52-003-GI2936: the mica 4s $5 S0.
WI
042
NEW AIDS DEFINITION WILL SIGNIFICANTLY INCREASE
NUMBER
OF CASES REPORTED
TO ADEOUATELV CAPTURE
BUT MAY STILL FAIL
SDME MAJOR RISK GROUPS
A new delinrtion of acouired lrnrnunodeliciency syndrome (AIDS), expected In 1992 from the
Centers lor Disease Corttrol (CDO),
would Increase the number of cases reported but could stlll leave some
major rlsk groups underrepresented, says the congressional Olflce of Technology Assessment (OTAI In a
The AIDS case tlcnnrtlon, first devetoped by the CDC
primary
In t9&2 and revised In 1955
public health surveillance tool used to determine the scope ol the AIDS epidetttlc
denning conditions inthe current delrnltton, rncludlng
pneumonia,
and l9B7,
is the
The 23 AIDSV
Kaposrs sarcoma and Prreumocystrs carinii
mark the linal stage In the progression of HIV inlection.
Thess AID$delinIng condltlons are
requirement lor a posnlve HIV antibody test), are consldcted to have AIDS
Sorne crltIcs have Iaulted the current dellnitlun ol AIDS for not including
some severe
untleresuntatron ofthe impact of the epidemic on these populations and hindering their access to Federal
The CDC's proposed AIDS case dellnitlon wlll Include all Hlvinlected
of more of tive 23 AIDS·delInIng conditions included In the current dennrtlon,
will be expanded to include all
cubic
mtlllmeter
HIV»positIve persons with CD4
of blood.
The CD-4*
proposed expansion inthe AIDS case tleltnition will
States by 52
lymphocyte 030 counts below 200 cells per
lymphocyte count is a laboratory measure of the progression
scvnral advantages for AIDS surveillance, says OTA
to
persons who have any one
In addition. the case definition
AIDS surveillance data will better tellect the extent ol
increase the total number of AIDS cases In the United
percerttr and Slate and Iocal health depanments estimate that the increase will
t35 percent
AIDS case reporting may be slmplllied
physicians to monitor the CD4`
be facilitated by enlisting
because It ls a standard ol clinlcal
lymphocyte counts of thelr HlV
clinical laboratories that perform ODP
OTA notes that despne its advantages, the CD4'
surveillance tool
024lniected patlenls
testlng to help
range lront J6
care lor
AIDS survelllance may
dentlty potential AIDS
lymphocyte count is not a perfect AIDS
Because ntany HlIIrInfected persons wltlt a CD4'
lymphocyte count below 200
cells/mm3 will be syrnptomrfree and may not seek health care, the completeness of reporting may be
dlltlcultto assess
Furthermore. populations with better access to testing will
Identrried AIDS cases
HIV
024infected women and Inteetlon drug
ol otherAIDS risI< groups, ana may have less access to CD4'
testing
The proposed detinition will,
however, capture an Increasing proportion ol proloundly lmmunosuppressed
Injection drug users who do not have AlDSrdelining
be ovevrepresented among
users are on average poorer than members
conditions
HIV·Infectedwomen and
ln ma ms: ynars altar the pmposm msn uslinniun
me CDC will
is lmplsmsmsd. spldsmlclcglsu nnlldpam than
mss hs abimyw Mlow lrnnds mms kncbdancs cl AIDS.
(mcse Hlwniecisd persons who nurrnnuy have a CD4'
Huwuvnr, anu all prevalent cans
lymphocyte count haicw 2¤¤ news/mm] bm whn
Wm prupusm chang: m mu AIDS case delmmon raises privacy concnms becausn mms w¤\l bs an
depanmsms.
\n planning to Implementthe new dshrmlon,
States should reassess cunent iaws am
operational procedures mst protect me uunnuanualny no CD4'
ms: results
In addhiun. several Suxes have
proposed xc have dwmcal hburarsvnas vnpcnmz namas ci persons wnh Iuw CDV
State and local heahh departments
CD4'
lymphnoyn count mn
lymphocyte nunmsm
The State and local hwlh departments mn msn aumwrup wnh lhs
be daprsssod \n utherdlsoasas. soma persons reported as llkuy AIDS msu
Thr CDC msn dstlrmlnn hu also been used asa cllnlcal duflrmlun
pmmculs, and In me alfocatlun ul Federal funds undnrms Ryan Whlu
by physlclans,
In rssanrnh
Oompmhnnstvs Resources
aware that more ws a broader spectrum or Hlvassocwalnd cundnions mnn \s mulndnd
in me AIDS
quafly Qnrinnding under ma Ryan Whks Cnmpmhenslva Resources Emergency Act ot l990, and me
mcrsasu in AIDS cases may allsrrhe dlstrlbmlcn nl Iunds among rnaunpnlnan
addvunn,
areas and States,
ln
mum cnies and States ww bs sugwuhaIc1|unds1rcmkheAID5 Huuslnq Oppnnunny Act :1+ \990,
although me U.$
Department ul
Housing and Urban Dnvelupmsnt has yn to dlsmnma Vunds under ma
The CDC dn¤nArl¤n has been used as a measure cl dlsahnlhy in benem prugramsadrmnistemd by
Una Soclm Se
042:urnyA¤m¤nis\rz\inn (SSA) In mu Department ¤1 Health and Human Services
bewng wrongly denied dlsabwlny bermhs because muh
dehnnicn,
The uso mths
wllrwsses were nm included nn mn AIDS case
Fav many pecpde, slignbimy mr Social Sscumy disablny bensms also snahluslhnmm nblaln
Medkcald, a Fndsrm/Slalsriundnd medical msuruncs program
disability henems are awarded Chess henefns.
The Social Securi|yAdminisxrzu0n has
Nnnarhdass, ma numnmus examplns cl H\V·inle¤1m1
The SSA recently issued requluxions suhstamially rwlslnq ns dfsnlulhy cmena Qnrail HW-inlsctsd
persons, inducing
persons wnh AIDS.
AIDS advocates as bam; mu
The wucriteria, which have ham cmlclzod
by medical groups and
rutrinivs. demcnsxnuexhamuu dnnqa In mn CDC definnlnn ci AIDS w\ll nm
Copies ui the Gibpage backgmund paper The CDC': Casa Dehniricn nIAI¤S·
Proposed Ruvlslcns Var cungressmnal
use can be urdsred bum
D.C
20402-9325;
phnne
use an nvawabls hy rzlling A-9241
me Supennmndent ul Documents, U
(2112)
Tmruzas.
S
Implications ol me
Ocprnslur nuncnngrssslunsl
Gcvemmem Pnnung Omoo, Washingmn.
Th: GPO order numhu Is B52-003-GI2936: the mica 4s $5 S0.
WI
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