Worldwide, the number of patients with HIV is continuing to grow dramatically, with current estimates of 30.6 million people living with HIV or AIDS. Since the beginning of the epidemic, 11.7 million people are reported to have died from HIV-related illnesses. If current trends continue, 60 to 70 million people will be infected with HIV by the year 2000. Developing countries, the least equipped to deal with the epidemic, have been hit particularly hard.
In the United States, HIV surveillance has improved as a result of new laws requiring mandatory reporting of HIV seropositivity in over 20 states. As of December 31, 1997, there were an estimated 1.1 million people infected with HIV (approximately 1 in every 250 Americans). Reported cases of AIDS number 641,086, and 390,692 patients with HIV-related deaths have been described.2 AIDS is now the leading cause of death among American men 25 to 44 years old and the third leading cause of death among women in the same age group. Regional trends have changed markedly over the past decade. While more than 50 percent of AIDS cases occurred in five urban centers through 1987 (New York, San Francisco, Los Angeles, Newark, and Miami), the majority of new HIV cases now occur outside these centers, with the most significant increases seen in smaller metropolitan areas.
Risk factors commonly associated with HIV infection include homosexuality or bisexuality, injected drug use, heterosexual exposure, receipt of a blood transfusion prior to 1985, and vertical and horizontal maternal-neonatal transmission. The change in the distribution of AIDS cases by mechanism of transmission since the start of the HIV epidemic is shown in Table 139-2.3
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