title: Emerging patterns of HIV transmission: the value of alternative surveillance methods.
abstract: OBJECTIVE
  To assess the current patterns of HIV transmission in Los Angeles County and determine if AIDS surveillance data accurately reflect these patterns.
  
  
  METHODS
  Records-based cohort study.
  
  
  METHODS
  The demographic and HIV risk characteristics of persons considered to be recently infected with HIV (CD4+ count > 700 x 10(6)/l) were determined and compared with the characteristics of persons meeting the Centers for Disease Control and Prevention (CDC) 1993 AIDS case definition. Data were obtained for patients with HIV infection enrolled from four HIV outpatient clinics and analyzed between August 1991 and July 1993.
  
  
  RESULTS
  The patient cohort included 1857 persons with HIV infection; 1096 (59.1%) met the CDC 1993 AIDS case definition and 134 (7.2%) had a CD4+ lymphocyte count > 700 x 10(6)/l. The median CD4+ count for the group presumed to be recently infected was 809 x 10(6)/l. Persons considered recently infected with HIV were more likely than those meeting the AIDS case definition to be female (26.1 and 14.5%, respectively; P < 0.001), black (28.4 and 18.2%, respectively; P = 0.001), or male homosexual injecting drug users (IDU; 6.7 and 3.4%, respectively; P = 0.05). After controlling for confounding variables by logistic regression, persons recently infected were more likely to be female [adjusted odds ratio (OR), 3.4; 95% confidence interval (CI), 1.8-6.5; P < 0.001], black (adjusted OR, 1.6; 95% CI, 1.1-2.5; P = 0.02) or male homosexual IDU (adjusted OR, 2.4; 95% CI, 1.1-5.2; P = 0.02) than persons with AIDS.
  
  
  CONCLUSIONS
  Our results suggest that the HIV epidemic in Los Angeles County is currently advancing into different subpopulations and indicate that the current patterns of HIV transmission in the County are not fully reflected in standard AIDS surveillance  activities. However, our data must be interpreted cautiously because of potential selection and misclassification biases. These findings illustrate the benefits of alternative surveillance mechanisms in detecting important changes in HIV transmission and defining groups at risk, especially in jurisdictions without HIV reporting.
authors.affiliation: HIV Epidemiology Program, Los Angeles County Department of Health Services, CA 90005, USA.
authors.forename: F
authors.initials: F
authors.lastname: Sorvillo
authors.forename: P
authors.initials: P
authors.lastname: Kerndt
authors.forename: K J
authors.initials: KJ
authors.lastname: Cheng
authors.forename: G
authors.initials: G
authors.lastname: Beall
authors.forename: P A
authors.initials: PA
authors.lastname: Turner
authors.forename: V L
authors.initials: VL
authors.lastname: Beer
authors.forename: A
authors.initials: A
authors.lastname: Kovacs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology / Q000635:transmission*; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors