COMMUNICABLE DISEASES

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
Acquired Immunodeficiency Syndrome (AIDS) is a specific group of diseases or conditions which are indicative of severe immunosuppression related to infection with the Human Immunodeficiency Virus (HIV). HIV infection typically occurs several years before the development of life-threatening symptomatic illness and AIDS, which is defined by the diagnosis of specific opportunistic infections and severe CD4+ T-lymphocyte depletion.

AIDS Incidence, 1981-1999
The number of AIDS cases diagnosed among New Jersey residents peaked in 1993 and then declined through 1998. This decline in AIDS incidence appeared to stabilize in 1999 (1,735 cases), but still remained below the 1987 level (Table C1). Two-thirds of the cumulative cases of AIDS diagnosed through 1999 are known to have died, though not necessarily due to HIV/AIDS (Table C1).

HIV/AIDS Incidence, 1992-1999
Persons initially diagnosed with HIV/AIDS in the year 1999 numbered 2,243, which is the lowest number of new cases diagnosed since HIV infection reporting was initiated in October 1991 (Table C2). Date of initial HIV/AIDS diagnosis is marked by the first HIV positive test recorded in the HIV or AIDS case report. First positive tests typically occur several years after persons have been infected with HIV but often some time before they develop symptomatic illness and are diagnosed with AIDS. Thus, cases diagnosed with HIV/AIDS in 1999 tend to reflect persons somewhat more recently infected and at an earlier stage of disease progression than cases diagnosed with AIDS in 1999.

Prevalence of Persons Living with HIV/AIDS, 1999
The prevalence of New Jersey residents living with HIV/AIDS during 1999 numbered 29,472 (Table C3); this includes all persons who were alive at the beginning of 1999 and who were diagnosed with HIV/AIDS before the end of 1999. While incidence measures indicate trends in new cases, prevalence measures are useful for describing the population of persons currently in need of HIV/AIDS services. Although incidence of new case reports has declined during the late 1990s, there have been even greater declines in mortality of HIV/AIDS patients; therefore, prevalence of persons living with HIV/AIDS has tended to increase.

For persons living with HIV/AIDS in 1999 with a known/reported mode of transmission, the distribution by mode was 47 percent injection drug use (IDU), 22 percent heterosexual contact with a person with/at risk of HIV, 20 percent male sex with male contact (MSM), 4 percent both MSM and IDU, 6 percent perinatal transmission /other pediatric modes and 1 percent blood-related modes (transfusion and hemophilia/coagulation disorder) (Table C3). Thirty-six percent of New Jerseyans living with HIV/AIDS were female. Considering the current age of persons in 1999 (which is often several years older than their age at first diagnosis), the modal age groups of persons living with HIV/AIDS were 40-49 years old for males and 30-39 years old for females. The rates for both males and females by race/ethnicity were highest for black non-Hispanics, followed by Hispanics of any race (Table C5). The statewide prevalence rate in 1999 was 361.9 persons living with HIV Disease per 100,000 population; counties with prevalence rates higher than the statewide average were Essex (1,182.8), Hudson (713.1), Atlantic (544.6), Passaic (500.6) and Union (440.7) (Table C7 and Figure C2).

Trends in Perinatal Transmission of Pediatric HIV/AIDS
Pediatric follow-up on all children living with AIDS has been an ongoing routine surveillance activity in New Jersey since 1986. Follow-up was expanded in 1992 to accommodate those children now reported with HIV infection and/or perinatal exposure to HIV. Currently, all living HIV, AIDS, and perinatally-exposed children through age 18 years are followed six months after initial report or while their HIV status is indeterminate. If the child progressed on to HIV, then follow-up is conducted annually. Some children who initially test positive for HIV may later serorevert (become non-reactive to HIV antibodies). Children who have seroreverted are classified as not infected and are no longer followed.

In 1999, 220 perinatally exposed infants were born in New Jersey and reported to the HIV/AIDS Reporting System (HARS) (Table C4). Based on follow-up information obtained through June 30, 2001, 59 percent of the 220 reported infants had seroreverted, 36 percent were still HIV indeterminate, and only 5 percent were confirmed HIV. Historical data on confirmed pediatric HIV/AIDS cases by year of birth show major declines in the number and percentage of infected infants since 1993 (Figure C1). This trend is attributed mainly to the increasing availability and use of antiretroviral drugs during pregnancy and the perinatal period and to the effects of other pediatric HIV/AIDS prevention programs during the 1990s.

HIV/AIDS Mortality Trends
HIV/AIDS Mortality trends can be examined in two ways: by considering deaths specifically caused by HIV/AIDS or by considering deaths from any cause of persons reported with HIV/AIDS.

The Mortality chapter of this report presents data on the *** deaths in 1999 that were caused by HIV/AIDS, i.e. deaths with an underlying cause of death ICD-10 code ranging from B20 to B24. Distributions of these *** deaths are presented by age group, race and sex, and county of residence (Tables M36 through M39).

In this chapter, a brief summary is provided of deaths from any cause of persons reported with HIV/AIDS. In 1999 there were 1,276 known deaths from any cause that occurred among persons reported with HIV/AIDS, which represented a 7 percent increase over the 1998 total (Table C6). Deaths of HIV/AIDS patients increased each year from 1990 through 1995, and then showed major declines in 1996 through 1998, reflecting advances in antiretroviral therapy. The slight increase in 1999 may indicate an end to the declining trend of the previous three years.

Tuberculosis (TB)
For the sixth year, the number of reported TB cases declined (Table C8 and Figure C3). The highest rates of TB occurred among those aged 25-34 and 65 and over. The rate for males was 1.6 times the rate for females. Whites had the lowest TB rates, followed by blacks and persons of races other than white or black, respectively. The highest rates were among other race males aged 25-34 (65.8 per 100,000 population) (Table C9). Hudson and Essex Counties had rates more than twice that of the state as a whole (Table C10).

Sexually Transmitted Diseases (STDs)
In 1999, syphilis cases continued to decline while gonorrhea cases remained stable and chlamydia cases increased (Table C11). The highest rate of syphilis occurred among those aged 30-34, while gonorrhea's highest rate was among 20-24 year olds and chlamydia's was among those 15-19 (Table C12). Essex County had syphilis, gonorrhea, and chlamydia rates more than twice that of the state. Camden and Mercer Counties' gonorrhea rates were also more than double the state rate (Table C13).

Other Reported Diseases
Reported cases of Lyme disease continued to decline in 1999, dropping 10.6 percent from the number of cases in 1998. Salmonella reports also continued to decrease, with 21.4 percent less than the previous year (Table C14). Reports of vaccine-preventable diseases remained stable or decreased between 1998 and 1999 (Table C15).

The Technical Notes section contains information on sources of data, allocation of data by residence or occurrence, quality of data, racial and ethnic classification, definitions, and rates and ratios.

COMMUNICABLE DISEASE DATA TABLES
Table C1	AIDS Cases by Year of Diagnosis, Vital Status, and Total Cases, 1981-1999
Table C2	HIV and AIDS Cases by Year of First HIV/AIDS Diagnosis and Current HIV/AIDS Status, 1992-1999
Table C3	Persons Living With HIV/AIDS by Mode of Transmission and Sex
Table C4	Pediatric HIV/AIDS Cases and Exposures by Category, 1993-1999
Table C5	Persons Living With HIV/AIDS by Age, Race/Ethnicity, and Sex
Table C5A	Prevalence Rates of Persons Living With HIV/AIDS by Age, Race/Ethnicity, and Sex
Table C6	Deaths From Any Cause Among Residents Reported With HIV/AIDS by Year of Death, Gender, and Race/Ethnicity, 1990-1999
Table C6A	Percentage Change from Previous Year in Deaths From Any Cause Among Residents Reported With HIV/AIDS by Year of Death, Gender, and Race/Ethnicity, 1990-1999
Table C7	Persons Living With HIV/AIDS by County of Residence
Table C8	Tuberculosis Incidence and Mortality, 1989-1999
Table C9	Verified Tuberculosis Cases by Age, Sex, and Race
Table C10	Tuberculosis Incidence by County
Table C11	Reported Incidence of Sexually Transmitted Diseases, 1989-1999
Table C12	Reported Incidence of Sexually Transmitted Diseases by Age Group
Table C13	Reported Incidence of Sexually Transmitted Diseases by County
Table C14	Reported Cases and Rates of Frequently Reported Communicable Diseases
Table C15	Reported Cases of Vaccine-Preventable Communicable Diseases
MORBIDITY ILLUSTRATIONS
Figure C1	Pediatric HIV/AIDS Cases and Exposures by Year of Birth, 1972—1999
Figure C2	Persons Living With HIV/AIDS by County of Residence
Figure C3	Tuberculosis Incidence, 1989-1999

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