This study sought to determine why young men who have sex with men (MSM) have higher HIV incidence rates than older MSM in the United States. We developed hypotheses that may explain this disparity. Data came from peer-reviewed studies published during 1996-2016. We compared young and older MSM with respect to behavioral, clinical, psychosocial, and structural factors that promote HIV vulnerability. Compared with older MSM, young MSM were more likely to have HIV-discordant condomless receptive intercourse. Young MSM also were more likely to have "any" sexually transmitted infection and gonorrhea. Among HIV-positive MSM, young MSM were less likely to be virally suppressed, use antiretroviral therapy, and be aware of their infection. Moreover, young MSM were more likely than older MSM to experience depression, polysubstance use, low income, decreased health care access, and early ages of sexual expression. These factors likely converge to exacerbate age-associated HIV incidence disparities among MSM.

For epidemiologic surveillance of HIV infection in the United States, until this year, the staging system for adults (published in 2008) had been separate from the classification system for children (published in 1994).1,2 To design a single staging system for both adults and children based primarily on absolute CD4 T-lymphocyte counts, we retained the age-specific CD4 count thresholds used to define the boundaries between stages 1, 2, and 3 (called “immunologic categories” rather than “stages” in the 1994 classification for children). Values greater than or equal to the upper threshold indicate stage 1, values less than the upper threshold but greater than or equal to the lower threshold indicate stage 2, and values less than the lower threshold indicate stage 3 (AIDS). For children aged <1 year, the lower and upper CD4 count thresholds are 750 and 1500 (cells/μL); for children aged 1 to <6 years, they are 500 and 1000; for children aged 6 to <13 and for adults and adolescents aged 13 or older, they are 200 and 500. | Those staging/classification systems used both the absolute CD4 count and the CD4 percentage of total lymphocytes to classify cases into stages; if the CD4 count and the CD4 percentage indicated different stages, the more advanced of the 2 stages was selected. If one of these measurements was not available, the classification was based solely on the other measurement. The lower and upper CD4 percentage thresholds in those staging/classification systems were 15% and 25% for all 3 age groups of children, and 14% and 29% for adults and adolescents.1,2 In developing an updated staging system, we reassessed the relationship between the CD4 counts and the CD4 percentages and selected the mean CD4 percentage corresponding to each CD4 count threshold.

Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged <13 years). The revisions were made to address multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age.

OBJECTIVE: The goal of this study was to examine associations between demographic, behavioral, and clinical variables and mother-to-child HIV transmission in 15 US jurisdictions for birth years 2005 through 2008. METHODS: The study used Enhanced Perinatal Surveillance system data for HIV-infected women who gave birth to live infants. Multivariable logistic regression was used to assess variables associated with mother-to-child transmission. RESULTS: Among 8054 births, 179 infants (2.2%) were diagnosed with HIV infection. Half of the births had at least 1 missed prevention opportunity: 74.3% of infected infants, 52.1% of uninfected infants. Among 7757 mother-infant pairs with sufficient data for analysis, the odds of having an HIV-infected infant were higher for women who received late testing or no prenatal antiretroviral medications (odds ratio: 2.5 [95% confidence interval (CI): 1.5-4.0] and 3.5 [95% CI: 2.0-6.4], respectively). The odds for mothers who breastfed were 4.6 times (95% CI: 2.2-9.8) the odds for those who did not breastfeed. The adjusted odds for women with CD4 counts <200 cells per microliter were 2.4 times (95% CI: 1.4-4.2) those for women with CD4 counts ≥500 cells per microliter. The odds for women who abused substances were twice (95% CI: 1.4-2.9) those for women who did not. CONCLUSIONS: The odds of having an HIV-infected infant were higher among HIV-infected women who were tested late, had no antiretroviral medications, abused substances, breastfed, or had lower CD4 cell counts. Increases in earlier HIV diagnosis, substance abuse treatment, avoidance of breastfeeding, and use of prenatal antiretroviral medications are critical in eliminating perinatal HIV infections in the United States.

OBJECTIVE: Although perinatal HIV infections are declining in the United States (U.S.), there is no single source of nationally representative data available to estimate the number of infants born to HIV-infected women in the U.S. and its dependencies. This study determines the total number of births to HIV-positive women in the U.S. in 2006. STUDY DESIGN: Diagnosed Stage 1 or 2 HIV disease in the U.S. were based on reported data from 39 areas that conducted confidential name-based HIV case reporting and Stage 3 HIV from all areas in the U.S. A zero-inflated Poisson (ZIP) model was used to estimate the number of women aged 13-44 years living with diagnosed Stage 1 or 2 HIV disease in the U.S. The number of undiagnosed HIV-infected women (Stage 1 or 2) of childbearing age was estimated from the number of reported Stage 3 HIV (i.e., AIDS) cases using a back-calculation method. RESULTS: An estimated 115,200 women aged 13-44 years were living with Stage 1 or 2 HIV disease in 2006. A total of 56,200 women were living with diagnosed Stage 3 disease. The estimated number of births to all women living with HIV disease (diagnosed or undiagnosed) was 8,700 [95% Confidence Interval (CI): 8,400-8,800] in 2006. CONCLUSIONS: The number of infants born to HIV-infected women in 2006 was approximately 30% greater than the number of such births (6,075-6,422) in 2000. This increase highlights the need to continue and strengthen efforts to prevent perinatal HIV transmission in the U.S.

BACKGROUND: To encourage evidence-based practice, an Annals of Internal Medicine editorial called for a new professional on clinical teams: an informationist trained in science or medicine as well as information science. OBJECTIVES: The study explored the effects of informationists on information behaviors of clinical research teams, specifically, frequency of seeking information for clinical or research decisions, range of resources consulted, perceptions about access to information, confidence in adequacy of literature searches, and effects on decision making and practice. It also explored perceptions about training and experience needed for successful informationists. METHODS: Exploratory focus groups and key interviews were followed by baseline and follow-up surveys conducted with researchers and clinicians receiving the service. Survey data were analyzed with Pearson's chi-square or Fisher's exact test. RESULTS: Comparing 2006 to 2004 survey responses, the researchers found that study participants reported: seeking answers to questions more frequently, spending more time seeking or using information, believing time was less of an obstacle to finding or using information, using more information resources, and feeling greater satisfaction with their ability to find answers. Participants' opinions on informationists' qualifications evolved to include both subject knowledge and information searching expertise. CONCLUSION: Over time, clinical research teams with informationists demonstrated changes in their information behaviors, and they valued an informationist's subject matter expertise more.