Document 0879
 DOCN  M9650879
 TI    The incidence and prevalence of AIDS and prevalence of other severe HIV
       disease in England and Wales for 1995 to 1999: projections using data to
       the end of 1994.
 DT    9605
 SO    Commun Dis Rep CDR Rev. 1996 Jan 5;6(1):R1-21. Unique Identifier :
       AIDSLINE MED/96166069
 AB    Projections of the future incidence of AIDS cases are needed for
       planning purposes, to help set research priorities, and to describe the
       most likely pattern of transmission of HIV infection in the past that
       underlies the observed and projected incidence of AIDS. Earlier reports
       of projections for England and Wales were published in 1988, 1990, and
       1993. During 1995 a group of experts has worked, using AIDS case reports
       to the end of December 1994, to make new projections to the end of 1999.
       The expert group concludes that, after adjustment for underreporting,
       there will be between 1840 and 2300 new cases of AIDS in England and
       Wales in 1997, and between 1760 and 2455 new AIDS cases in 1999. For
       planning purposes, a figure of 2025 new AIDS cases is projected for
       1997, and 2010 for 1999. The planning projections for new AIDS cases in
       1997 and 1999 among the main exposure categories, after adjustment for
       underreporting, are as follows: homo/bisexual males 1305 and 1235,
       people exposed heterosexually 490 and 525, and injecting drug users 140
       and 155. Between 1995 and 1999, it is expected that new AIDS cases may
       fall by 7% in homo/bisexual males, and rise by 25% in the heterosexual
       exposure category and by 29% in injecting drug users. The incidence of
       AIDS in the children of mothers infected with HIV is expected to rise
       steadily from 30 new cases in 1994 to 45 in 1997 and 55 in 1999. New
       cases in recipients of contaminated blood or blood factors are expected
       to fall to 35 in 1997 and 30 in 1999, compared with a peak 10 years
       earlier of over 70 new cases each year. It is projected that 4010 AIDS
       cases will be alive in England and Wales at the end of 1999, and that
       the same number of people will be alive with other forms of severe HIV
       disease. Since 1989 the proportion of reported AIDS cases who live in
       the NHS Thames regions has remained constant at between 70% and 75%. We
       expect this concentration of AIDS cases in the south east, particularly
       within London, to remain unchanged. Compared with the report published
       in June 1993, the planning projections for 1997 are 37% lower for cases
       acquired heterosexually, and the upper boundary of the range in this
       exposure category has fallen from 1140 to 495. The reduction in the
       planning projection has resulted from a substantial decline in the rate
       of increase in the number of new AIDS cases arising each year from
       heterosexual exposure. The range of uncertainty has narrowed largely
       because more extensive seroprevalence data are now available. For
       homo/bisexual males, the planning projection for 1997 has fallen by 3%,
       because the 1993 report presented an over optimistic view of the extent
       to which patients received treatment and prophylaxis before the onset of
       AIDS, since such management became available in 1988. Unlike the 1993
       working group, the 1995 working group has access to data from several
       years on the uptake of treatment and prophylaxis given before the
       diagnosis of AIDS. It is estimated that about 21,900 adults (range
       20,400 to 23,400) were infected with HIV in England and Wales at the end
       of 1993. This total includes 12,350 who had been infected through male
       homosexual exposure, 2050 men and women infected through injecting drug
       use, 6800 men and women infected through heterosexual exposure, and
       about 3000 adults alive with AIDS. Various data indicate that HIV
       transmission among homo/bisexual men has been substantial since 1989.
       Use of data from the unlinked anonymous HIV prevalence monitoring
       programme suggest that between 500 and 1000 HIV infections due to
       homosexual male exposure occurred each year in 1992 and 1993. Should HIV
       transmission continue at this level, a high incidence of AIDS within the
       homo/bisexual male community will be inevitable for many more years.
       Most HIV infections and AIDS cases due to heterosexual exposure are
       thought to have been acquired abroad. The future of the epidemic in this
       exposure category is therefore unclear.
 DE    Acquired Immunodeficiency Syndrome/DRUG THERAPY/*EPIDEMIOLOGY/
       MORTALITY/TRANSMISSION  Adolescence  Adult  Disease Transmission,
       Vertical  England/EPIDEMIOLOGY  Female  Forecasting/METHODS  Human  HIV
       Infections/DRUG THERAPY/*EPIDEMIOLOGY/MORTALITY/TRANSMISSION  Infant,
       Newborn  Male  Population Surveillance/*METHODS  Risk Factors  Survival
       Rate  Wales/EPIDEMIOLOGY  JOURNAL ARTICLE

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