Acquired Immunodeficiency Syndrome

In January, 1993, the Centers for Disease Control and Prevention (CDC) expanded the definition of AIDS to more accurately reflect the clinical syndromes that are associated with the condition. The definition was expanded to include individuals with the human immunodeficiency virus and one of the following conditions: a CD4+ T-lymphocyte count of fewer than 200 cells per microliter; a CD4+ T-cell percentage under 14; pulmonary tuberculosis; recurrent pneumonia (within a 12 month period); or invasive cervical cancer (CDC, 1992).

The number of AIDS cases newly diagnosed in New Jersey residents in 1996 and reported as of December 31, 1997 was 2,9561 (Figure C1 and Table C1). These cases include 981 reported under the pre- 1993 definition and 1,975 identified under the expanded 1993 AIDS definition. Cases of AIDS diagnosed in 1996 and reported through the end of 1997 are presented by county in Table C9 (Division of AIDS Prevention and Control, 1998b).

1Due to the time lag in reporting newly diagnosed cases of AIDS, the number of cases for any year will continue to increase for several years past the end of the calendar year. In recent prior issues of this report, AIDS incidence was defined as cases for the diagnosis year reported during the year of diagnosis and for two years past the end of the diagnosis year. Caution should be exercised in comparing incidence data for 1995 and 1996 presented in the respective years? reports with comparable data for earlier years presented in prior reports in the series, as the incidence figures for 1995 and 1996 were presented after only a one-year lag past the end of the diagnosis year.

TABLE C1. AIDS CASES BY YEAR OF DIAGNOSIS AND CUMULATIVE CASES REPORTED THROUGH DECEMBER 31, 1997 NEW JERSEY, 1981 - 1996
YEAR	NUMBER OF CASES (PRE-1993 DEFINITION)	NUMBER OF CASES (1993 DEFINITION)	CUMULATIVE CASES
PRIOR TO 1985	645	5	650
1985	795	5	1,450
1986	1,267	5	2,722
1987	1,808	17	4,547
1988	1,949	49	6,545
1989	2,431	133	9,109
1990	2,379	226	11,714
1991	2,459	369	14,542
1992	2,569	972	18,083
1993	2,642	2,360	23,085
1994	1,821	2,192	27,098
1995	1,267	2,314	30,679
1996	981	1,975	33,635
SOURCE: NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES DIVISION OF AIDS PREVENTION AND CONTROL

In 1996 almost all of the cases (93.3%) identified under the expanded 1993 AIDS definition were classified as having a CD4+ T-lymphocyte count of fewer than 200 cells per microliter or a CD4+T cell percentage of less than 14 (Table C2). An additional 3.3 percent of the cases reported under the new definition were each due to pulmonary tuberculosis and recurrent pneumonia, while the remainder were due to cervical cancer (0.2%). The 1,842 cases attributed to CD4+ categories represented 62.3% of all new cases diagnosed in 1996 (Division of AIDS Prevention and Control, 1998a).

TABLE C2. DISTRIBUTION OF CLASSIFICATION OF AIDS CASES IDENTIFIED THROUGH EXPANDED 1993 DEFINITION DIAGNOSED DURING 1996 AND REPORTED THROUGH DECEMBER, 1997 NEW JERSEY
CLASSIFICATION	NUMBER	PERCENT
PULMONARY TUBERCULOSIS*	66	3.3
RECURRENT PNEUMONIA*	66	3.3
CERVICAL CANCER	3	0.2
LOW CD4+T-LYMPHOCYTE COUNT	1,842	93.3
SOURCE: NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES DIVISION OF AIDS PREVENTION AND CONTROL *TWO CASES WITH BOTH PULMONARY TUBERCULOSIS AND RECURRENT PNEUMONIA ARE INCLUDED IN THE TABLE TWICE, ONCE EACH UNDER PULMONARY TUBERCULOSIS AND RECURRENT PNEUMONIA

By December, 1996, the cumulative number of AIDS cases ever reported in New Jersey was 32,287. New Jersey continued to rank fifth in the nation in the cumulative number of AIDS cases and had the fourth highest AIDS incidence rate per 100,000 population in 1996, after Washington, D.C. New York State and Florida. Analyses of the characteristics of New Jersey?s AIDS cases contained in this chapter are based on the population of all cases reported to the state through December 31, 1996, unless otherwise noted. Cumulative cases for the nation reported through the end of 1996 are used for purposes of comparison (Division of AIDS Prevention and Control, 1997, Centers for Disease Control and Prevention, 1998).

The distribution of mode of transmission of New Jersey's AIDS cases for persons 13 or more years of age differs considerably from the risk factors associated with the transmission of AIDS in adults and adolescents in the nation as a whole (Figure C2 and Table C7). Nationally, of all adult and adolescent cases reported through December 31, 1996, 25.5 percent were injecting-drug users, while 49.9 percent of New Jersey's cases reported they were injecting-drug users. In the country as a whole, 50.1 percent of AIDS cases were homosexual or bisexual males while in New Jersey only 21.5 percent of AIDS cases reported this means of transmission. The proportion of New Jersey's AIDS cases attributed to heterosexual transmission is slightly higher than in the nation as a whole (12.3% and 8.7%, respectively).

New Jersey continued to have a higher percentage of its AIDS cases diagnosed in children under five years of age than did the nation as a whole, although the gap may be narrowing (Martin, R.M., et al., 1998). Children under five accounted for 1.6 percent and 1.0 percent of total cases diagnosed and reported by December 31, 1996 in New Jersey and the U.S., respectively (Table C3). In both New Jersey and the nation as a whole, 30 through 39 year olds continue to be the most frequently diagnosed age group cumulatively through the end of 1996. Almost half of all New Jersey's ever-diagnosed cases (47.4%) were in this age group when diagnosed. In both the state and the United States as a whole, about 88 percent of AIDS cases have been diagnosed in persons between 20 and 49 years of age (Table C3).

TABLE C3. AIDS CASES BY AGE AT DIAGNOSIS NEW JERSEY AND THE UNITED STATES CUMULATIVE CASES REPORTED THROUGH DECEMBER 31, 1996
Age Group	NEW JERSEY		UNITED STATES
	NUMBER	PERCENT	NUMBER	PERCENT
UNDER 5	503	1.6	6,032	1.0
5 - 12	152	0.5	1,597	0.3
13 - 19	140	0.4	2,754	0.5
20 - 29	4,800	14.9	102,904	17.7
30 - 39	15,291	47.4	263,726	45.4
40 - 49	8,385	26.0	144,992	24.9
50 & OVER	3,016	9.3	59,424	10.2
TOTAL	32,287	100.0	581,429	100.0
SOURCE: NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES DIVISION OF AIDS PREVENTION AND CONTROL

For those cases diagnosed in persons 13 or more years of age, New Jersey has a higher percentage of female AIDS cases than does the nation as a whole. The cumulative percentage of adult and adolescent cases diagnosed in New Jersey through the end of 1996 included 26.4 percent who were females, compared to 14.9 percent of female cases in the U.S. (Table C8).

New Jersey also differs from the rest of the nation in the racial and ethnic composition of its adult and adolescent AIDS cases (Table C8). More than half of New Jersey's cases (54.5 percent) have been diagnosed among non-Hispanic blacks, while about one-third of the nation?s cases (34.6%) were diagnosed in non-Hispanic blacks. By the end of 1996, more than two-thirds of New Jersey's AIDS cases (70.6%) and about half (52.3%) of the nation's cases were diagnosed in non-Hispanic blacks and Hispanics of all races.