The completeness of AIDS case reporting in New York City.

OBJECTIVE--To assess the completeness of acquired immunodeficiency syndrome (AIDS) case reporting in New York City (NYC), and to determine whether the completeness of reporting differs in various populations. DESIGN--Retrospective record review of hospital laboratory logs, death certificates, hospital discharge records, and patient registries at private physicians' offices and hospital outpatient clinics. SETTING--Public and private hospitals, and private physicians' offices in NYC. PATIENTS--Adults and adolescents with AIDS or with illnesses suggestive of AIDS were identified using both population-based and nonrandom sampling techniques. These persons were matched with the NYC AIDS case registry, and the medical records of nonmatching persons were reviewed to determine whether they met the 1987 Centers for Disease Control and Prevention surveillance case definition for AIDS. MAIN OUTCOME MEASURES--The completeness of reporting was calculated for the five individual projects and for the aggregate database by gender, race/ethnicity, risk, borough of residence, age, first AIDS diagnosis, and year of diagnosis. RESULTS--Of 7015 persons with AIDS identified in the five projects, 5912 (84%) had been previously reported (range, 77% to 89%). The completeness of reporting ranged from 81% to 87% in all major gender, race/ethnicity, risk, borough of residence, and age subgroups. In a multivariate analysis, the odds of being unreported were significantly higher among outpatients in hospital clinics, out-of-state residents, persons with diagnoses other than Pneumocystis carinii pneumonia, and persons recently diagnosed with AIDS. CONCLUSIONS--This study indicates that the NYC AIDS surveillance system functioned effectively during the first decade of the AIDS epidemic. Completeness-of-reporting studies are an integral part of AIDS surveillance, providing data that are critical for assessing the validity of the AIDS surveillance database.

The spectrum of HIV-1-related disease among outpatients in New York City.

OBJECTIVES: To define the spectrum of HIV-1-related disease in New York City (NYC) and to determine how the clinical spectrum of illness differs in various populations. DESIGN AND METHODS: The medical records of the 2983 HIV-infected individuals who had received care through 1989 at four hospital outpatient clinics and two private physicians' offices were reviewed retrospectively. RESULTS: Sixty-one per cent of the study patients and 48% of patients seen in 1989 had AIDS. HIV-infected women were significantly less likely to have AIDS and CD4 lymphocyte counts less than 200 x 10(6)/l than men. For every 100 AIDS patients seen in 1989, there were 88 non-AIDS patients with CD4 counts less than 500 x 10(6)/l, of whom 41 had CD4 counts less than 200 x 10(6)/l; thus, in addition to an estimated 16,425 individuals living with AIDS in NYC, we estimate that there are at least 14,454 HIV-infected individuals without AIDS with CD4 counts less than 500 x 10(6)/l, of whom 6734 have CD4 counts less than 200 x 10(6)/l. Men who have sex with men were significantly more likely to have Kaposi's sarcoma, cytomegalovirus disease and retinitis, cryptosporidiosis and lymphoma, and significantly less likely to have Pneumocystis carinii pneumonia, esophageal candidiasis, extrapulmonary tuberculosis (TB) and bacterial pneumonia than intravenous drug users. Whites were significantly less likely to have pulmonary TB than Hispanics, non-Haitian and Haitian blacks, toxoplasmosis than Hispanics and Haitian blacks, and salmonella septicemia than non-Haitian blacks. The frequencies of most diagnoses did not differ by sex; gynecologic diseases were recorded infrequently in the medical records of women in this study. CONCLUSIONS: These data indicate that there are more than 30,000 HIV-infected adults living in NYC with significant immunosuppression, that an increasing proportion of AIDS cases in NYC will occur among women, and that the spectrum of HIV-related disease varies markedly in different populations.