High HIV seroprevalence associated with gonorrhea: New York City Department of Health, sexually transmitted disease clinics, 1990-1997.

OBJECTIVE: To measure trends in HIV seroprevalence associated with gonorrhea in patients presenting to New York City Department of Health sexually transmitted disease (STD) clinics, 1990-1997 (n = 94 577). METHOD: Unlinked HIV-1 serosurvey using remnant serum originally drawn for routine serologic tests for syphilis (STS). Demographic, risk factor, clinical and laboratory data were abstracted from clinic charts. No other data sources were used. Patients were not interviewed. RESULTS: During 1990-1997 HIV seroprevalence declined from 9 to 6% (P for trend < 0.01) in the STD clinic sample. Gonorrhea incidence city-wide declined from 481 per 100 000 to 194 per 100 000. HIV seroprevalence in patients with a diagnosis of gonorrhea (n = 11 914) remained stable at 10-11% during the period, whereas HIV seroprevalence associated with all other STDs combined declined from 8 to 5% (P for trend < 0.01). Seroprevalence in women with gonorrhea (n = 2243) declined from 8 to 4% (P for trend < 0.001), whereas seroprevalence in men with gonorrhea was stable at 11-12%. Seroprevalence in men aged less than 25 years and diagnosed with gonorrhea declined from 5 to 3% (P for trend = 0.02). In contrast, in men aged 25 years and older and diagnosed with gonorrhea, seroprevalence remained at 14-16% throughout the period 1990-1997. Among men with gonorrhea, seroprevalence was associated with same gender or bisexual contact [odds ratio (OR), 9.2; 95% confidence interval (CI), 8.1-10.4], age > 25 years (OR, 5.1; 95% CI, 4.6-5.7), and white race/ethnicity (OR, 1.3; 95% CI, 1.2-1.4). CONCLUSIONS: In this 9-year serosurvey the association between HIV and gonorrhea remained strong during a period when HIV seroprevalence and gonorrhea incidence declined. The data suggest that a gonorrhea diagnosis is an important risk marker in this era of 'safe sex' and that behavior patterns of patients with gonorrhea warrant further study.

Incident syphilis among women with multiple admissions to jail in New York City.

Although early syphilis morbidity in New York City (NYC) has declined to a record low, syphilis seroreactivity among women jailed in NYC is approximately 25%. By use of a retrospective cohort-type analysis of longitudinal serologic and treatment data collected at the time of each incarceration, the incidence of syphilis infection among 3579 susceptible women jailed multiple times in NYC between 23 March 1993 and 10 April 1997 was estimated. Syphilis incidence densities were estimated by use of continuous, time-homogeneous Markov models. There was a total of 289 incident infections. The overall incidence density was 6.5 infections per 100 woman-years (95% confidence interval, 5.7-7.2), which exceeds the 1997 early syphilis rate among women in NYC by>1000-fold. The persisting high incidence of syphilis in this population underscores the importance of aggressive syphilis control in correctional settings, even in the face of declining local early syphilis rates.

Trends in HIV seroprevalence in men who have sex with men: New York City Department of Health sexually transmitted disease clinics, 1988-1993.

OBJECTIVE: To measure HIV seroprevalence trends in a primarily non-white sample (n = 1618) of men who have sex with men (MSM). The MSM were sampled at New York City Department of Health (NYC-DOH) sexually transmitted disease (STD) clinics during 1988-1993. DESIGN: Unlinked HIV-1 serosurvey using remnant serum originally drawn for routine syphilis screening. METHOD: Demographic, clinical and risk exposure data were abstracted from clinic charts. No other sources of data were used, and patients were not interviewed. RESULTS: HIV seroprevalence in the overall sample declined from 53 to 34% between 1988 and 1993. The most dramatic decline was observed in white MSM (from 47 to 17%; n = 457). Seroprevalence in black MSM also fell (from 60 to 45%; n = 691). Seroprevalence in Hispanic men (n = 332) showed no decline, starting and ending the 5-year period at 39%. Bisexual MSM, who comprised one-quarter of the sample, experienced a shallower decline than other MSM (from 41 to 33%). The magnitude of the decline decreased with increasing age--for example, seroprevalence in MSM aged 20-24 years dropped by 62% (from 39 to 15%), whereas seroprevalence in MSM aged 40-44 years dropped by 10% (from 48 to 43%)--up through age 45 years, at which point another dramatic decline (from 53 to 21%) was observed. There was no decline in the high seroprevalence associated with a discharge diagnosis of gonorrhea (58%) or any genital ulcer disease (GUD; e.g., primary or secondary syphilis, chancroid or genital herpes, 52%). The proportion of STD diagnoses attributed to GUD rose from 8 to 14%. CONCLUSION: A small number of MSM continued to present to NYC-DOH STD clinics and to leave with a diagnosed STD at a time when safe sex was aggressively promoted. The biological and behavioral associations between GUD and gonorrhea and HIV seroprevalence warrant continued investigation. Prevention programs targeted to young, minority and bisexual MSM are needed.

Increasing HIV-1 seroprevalence associated with genital ulcer disease, New York City, 1990-1992.

OBJECTIVE: To measure HIV seroprevalence trends associated with sexually transmitted diseases (STD) causing ulcerative lesions [genital ulcer disease (GUD)], such as syphilis, chancroid and genital herpes, in New York City between 1990 and 1992. DESIGN: Unlinked HIV-1 serosurvey using remnant serum drawn originally for routine syphilis screening. SETTING AND PATIENTS: Consecutive sample of patients presenting to New York City Department of Health STD clinics for STD examination (n = 41,678). MAIN OUTCOME MEASURE: Serologic evidence of antibody to HIV-1. RESULTS: Although overall HIV seroprevalence and GUD incidence declined between 1990 and 1992, seroprevalence in patients with GUD increased from 10 to 16%. In contrast, seroprevalence in patients with non-ulcerative STD decreased. The most dramatic changes in seroprevalence associated with GUD occurred in patients using crack cocaine and injecting drugs. CONCLUSIONS: Despite declining HIV seroprevalence and GUD incidence, the association between GUD and HIV infection has strengthened over time in New York City STD clinics. Longitudinal incidence studies are needed to elucidate the biological, behavioral and temporal associations between GUD and HIV. Timely diagnosis and treatment of acute STD and more intensive risk reduction strategies at the clinics and associated testing sites, with a particular focus on GUD patients, are indicated.

HIV-1 seroprevalence in chest clinic and hospital tuberculosis patients in New York City, 1989-1991.

OBJECTIVE: To describe more fully HIV-1 and tuberculosis (TB) coinfection in TB patients attending New York City Department of Health chest clinics (1989-1991) and one inner-city hospital (1990-1991). DESIGN: An unlinked serosurvey using HIV-1-antibody testing of remnant blood specimens collected for routine medical purposes. SUBJECTS: A total of 1414 clinic and 856 hospital patients. OUTCOME MEASURES: HIV seropositivity and TB infection/disease. RESULTS: A total of 327 (23%) of the clinic patients were HIV-1-positive, with a significantly higher seroprevalence in men (29 versus 15%, P < 0.001) and in young and middle-aged adults aged 30-50 years (P < 0.001). HIV-1 prevalence by TB diagnostic class was: class 2 (purified protein derivative-positive and chest radiograph-negative), 11% (64 out of 570); class 3 (active disease), 34% (197 out of 582); class IV (old/inactive disease), 30% (39 out of 130). Of the hospital patients 487 (57%) were HIV-1-positive. HIV-1 seroprevalence was 55% for those who were identified or believed to be HIV-1-negative on admission as indicated on the medical chart. HIV-1 seroprevalence in the clinic population decreased initially, but later increased, although not to study onset levels. CONCLUSIONS: There is considerable overlap between the TB and HIV epidemics in New York City; a part of the increasing TB incidence may be independent of HIV coinfection. The control of TB will necessitate prompt diagnosis of TB and HIV-1, appropriate TB treatment and/or chemoprophylaxis, and a greater commitment to tackle the social conditions associated with the spread of the disease.

Trends in survival among persons with acquired immunodeficiency syndrome in New York City. The experience of the first decade of the epidemic.

This study examined survival trends among the 23,324 cases of acquired immunodeficiency syndrome (AIDS) meeting the Centers for Disease Control (CDC) definition that were diagnosed and reported to the New York City Department of Health from the beginning of the epidemic in 1980 through June 1989. The survival patterns of 20,760 individuals who survived for at least 1 calendar month beyond diagnosis were analyzed; all survival analyses were truncated at December 1, 1990, 17 months after the last diagnosis. Persons who died during the same month in which they were diagnosed ("zero" survivors) were excluded. Cases were examined by race/ethnicity, sex, age at diagnosis, calendar period of diagnosis, transmission category, CDC AIDS case definition (prior to and after the 1987 change in the AIDS case definition), and nature of diagnosis. Results of two- and three-way categorical analysis and logistic regression analysis are reported. Overall median survival time was 13.7 months (14.0 for males and 12.0 for females). Survival was better for whites than for blacks and Hispanics and was better for men who had sex with men than for injecting drug users. Each of the seven demographic and risk behavior factors was independently associated with survival. Trends in survival during three time periods indicated that survival is improving among all groups examined.

Trends in the first ten years of AIDS in New York City. The New York City Department of Health AIDS Surveillance Team.

With over 37,000 cases of acquired immunodeficiency syndrome (AIDS) reported by the end of 1991, New York City had reported nearly 20% of all US cases in the first decade of the AIDS epidemic. This report examines cases diagnosed through 1990 and reported through 1991 to describe rates and trends in the affected subpopulations. Case data were collected by the New York City Department of Health AIDS Surveillance Team, using a format standardized by the federal Centers for Disease Control. Deaths attributable to human immunodeficiency virus (HIV) infection were examined using data provided by the New York City Department of Health Bureau of Vital Statistics. From 1981 through 1990, 37,436 cases of AIDS were diagnosed: 83% in men over the age of 19 years, 15% in women over 19, 2% in children under 13, and less than 1% in teenagers aged 13-19. Cumulative rates in New York City adults were as high as 100 per 10,000 in nine neighborhoods. Predominant trends included a sustained plateau in reported incidence in men who reported having sex with men and a continuing rise in cases in injection drug users and women infected through heterosexual intercourse. HIV-related deaths in men, women, and children were continuing to rise at the end of the decade. During the first decade of the AIDS/HIV epidemic, case surveillance in New York City measured the visible portion of the epidemic and provided important data on subepidemics.

Abortions and HIV-1 infection in New York City, 1987-1989.

OBJECTIVE: This serologic survey was performed to determine rates of HIV-1 infection among New York City (NYC) women seeking abortions. DESIGN: Anonymous unlinked blood samples were collected and analyzed for the presence of HIV-1 antibodies. Abortion clinics were chosen for the representativeness of their patient population to all women obtaining abortions in NYC. SETTING: Blood samples and demographic information, including age group, race/ethnicity, borough of residence and type of payment were obtained from 15 abortion sites (11 clinics, four hospitals) in NYC between 1987 and 1989. PARTICIPANTS: A total of 5889 blood samples were collected from women seeking abortions. Twelve of the 15 facilities were sampled in all 3 years. MAIN OUTCOME MEASURES: We determined HIV infection rates in the overall sample and in selected subpopulations, and assessed temporal trends. Stepwise logistic regression was applied to identify factors independently associated with HIV-1 infection. RESULTS: The rate of HIV-1 infection in the overall sample was 1.19% (70 out of 5889) and remained stable in the 12 facilities sampled during all 3 years: 1987 (1.42%, 17 out of 1200); 1988 (1.67%, 20 out of 1200); and 1989 (0.90%, 27 out of 2989) (P = 0.09). Logistic regression identified receiving Medicaid and being aged between 25 and 35 years to be independently associated with HIV-1 infection. CONCLUSION: Approximately 1200 women seeking abortions annually in NYC are infected with HIV-1. If accessibility to elective abortion is curtailed, the number of children born to HIV-1 infected mothers will increase.

HIV-1 infection among New York City inmates.

A blinded seroprevalence survey for HIV-1 infection was conducted among individuals entering New York City (NYC) prisons in 1989. Data collected included age group, race/ethnicity, syphilis serologic results and self-admitted drug use. Remnant serum specimens were tested for HIV-1 antibody by enzyme-linked immunosorbent assay and confirmed by Western blot. Of 2236 inmates surveyed, 413 (18.5%) were HIV-1 positive. Rates varied by subgroup, and were higher for women than men (25.8 versus 16.1%; odds ratio 1.8; P less than 0.01), for drug users than inmates who denied drug use (25 versus 14%; odds ratio 2.3; P less than 0.01), for intravenous heroin users (43 versus 15% in drug users not using heroin), and for inmates with positive rapid plasma reagin test (RPR) results (34.5 versus 16.1% in RPR-negative inmates). Use of intravenous heroin was most strongly related, by logistic regression, to HIV-1 seropositivity. The results are among the highest found in US inmates, and suggest that there were 12,500 seropositive individuals incarcerated in 1989. This represents approximately 10% of the estimated number of seropositive individuals in NYC. The NYC Correctional System should be viewed as a front-line institution in the fight against AIDS through provision of HIV-related prevention services and clinical care, and drug treatment.

HIV seroprevalence in a facility for runaway and homeless adolescents.

In October 1987, the New York State Department of Health initiated a study to determine the prevalence of antibody to HIV in clients of a facility for runaway and homeless adolescents in New York City. A risk-assessment component was added in May 1988. As of December 1989, a total of 2,667 adolescents had been tested, and 142 (5.3 percent) were found to be HIV-seropositive (males 6.0 percent, females 4.2 percent). The seroprevalence rate increased from 1.3 percent for 15-year-olds to 8.6 percent for 20-year-olds. Hispanics had the highest seroprevalence rate (6.8 percent), followed by non-Hispanic Whites (6.0 percent) and non-Hispanic Blacks (4.6 percent). HIV seropositivity was associated with intravenous drug use, male homosexual/bisexual activity, prostitution, and history of another sexually transmitted disease. The alarmingly high prevalence of HIV infection in this selected population illustrates the immediate need for prevention programs for adolescents.

An outbreak of hepatitis A among cancer patients treated with interleukin-2 and lymphokine-activated killer cells.

An outbreak of hepatitis A virus (HAV) infection occurred among cancer patients treated with interleukin-2 (IL-2) and lymphokine-activated killer (LAK) cells between July and September 1986 at six different clinical centers. Among 85 patients tested serologically for recent HAV infection, 22 (39%) of 56 susceptible patients developed acute HAV infection. Only exposure to LAK cells cultured in medium containing human serum from two specific manufactured pools was associated with HAV infection. Attack rates were 85% among patients exposed to pool X, 62% in patients exposed to pool Y, and 50% in those exposed to both pools, compared with none among the 24 susceptible persons exposed to other serum pools (P less than .001). The serum used in production of LAK cell medium was obtained from multiple paid donors. Twenty persons donated plasma to both serum pools X and Y. Although none of 12 donors tested had evidence of recent HAV infection, it is likely that an asymptomatic plasma donor viremic for HAV contaminated both serum pools and the LAK cell medium made from it.

Delta hepatitis in homosexual men in the United States.

To assess the incidence and prevalence of delta hepatitis in homosexual men, we tested serum specimens for delta markers in participants in two previous studies: a hepatitis B vaccine trial among homosexual men conducted in the early 1980's and the Centers for Disease Control sentinel counties hepatitis study for 1983-1984. In the vaccine trial, men found to be hepatitis B surface antigen positive at the time of enrollment and those men who had serologic evidence of new hepatitis B virus infection during follow-up were tested. In the sentinel counties study that determined risk factors for viral hepatitis in reported cases, all homosexual men with acute and chronic hepatitis B virus infections were tested for delta markers. Specimens were tested for delta antigen and IgM and total delta antibody. In seven different cities, among 321 men found to be HBsAg positive at the time of screening, eight (2%) were positive for any delta marker. Among 290 men with new hepatitis B virus infections during follow-up, three (two coinfections, one superinfection) had serologic evidence of delta hepatitis. In the sentinel counties study, 0/63 acute hepatitis B virus infections in homosexual men were associated with delta hepatitis. This study indicates that the delta agent is an infrequent cause of viral hepatitis in homosexual men in the United States.