As cases were reported and analyzed under the broad CDC definition, common patterns emerged. It was found that various combinations of unusual infections, indirect measures of immune system function, and a rare cancer, Kaposi's sarcoma, characterized most of the reported cases. This lead the CDC to revise its definition of AIDS to reflect the most common manifestations presented by the reported cases. The revised criteria took the form of a list of the unusual infections and cancers, abnormal immune system tests, and other diagnostic findings that were significantly correlated with symptomatic HIV infection.These revised criteria were sufficiently restrictive to create a class of persons who were infected with HIV and had symptomatic disease but did not meet the CDC criteria for AIDS. These persons were identified as having ARC. Persons with ARC were not reportable, and their numbers did not count toward the CDC's running total of AIDS cases. Persons with ARC also had difficulty in qualifying for categorical programs funded for treating AIDS patients. Moreover, persons who were positive for the then newly discovered HIV but had no symptomatic disease were not reported and followed to track the epidemiology of the disease. In 1987 the CDC definition of AIDS was broadened to include neurological symptoms, wasting syndrome, and more common infections such as tuberculosis. This redefined many persons with ARC as persons with AIDS. In our view, once it was possible to test for the presence of HIV and it was proved that persons with AIDS or ARC were infected with HIV, then the presence of HIV or its antibodies should have become the reportable condition. Most states, however, persist in requiring AIDS cases to be reported but do not require the reporting of HIV-infected persons. This masks the epidemiology of the disease in women who do not fit the male-oriented standards for HIV. Given that the latency of AIDS may exceed ten years, counting AIDS cases rather than HIV infection makes it difficult to predict accurately the movement of the disease into new population groups. If the CDC again revises the definition of AIDS to include low T4-cell counts, it is estimated the number of persons with AIDS will double. Karposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR 1981 Jul 3; 30(25):305-8. 134Shilts R: And the Band Played On. 1987. Leads from MMWR, current trends; update: acquired immunodeficiency syndrome (AIDS)--United States. JAMA 1983; 250:1016. CDC: Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987; 36(suppl 1S). CDC: Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987; 36(suppl 1S). Chu SY; Buehler JW; Berkelman RL: Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States. JAMA 1990; 264:225-29.
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