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Show The HIV/AIDS Epidemic in Utah 1998 Kristen Ries, M.D. Abstract: HIV/AIDS remains an important cause of morbidity and mortality in Utah, despite Utah's rates being lower than those of the U.S. There has been a decrease in numbers that progress from HIV infection to AIDS and death, probably due to developments in available therapies. There are many difficulties in accurately tracking HIV infection; and it is unknown whether the decreases in deaths will continue or if there is merely a delay in the epidemic brought about by HAART (Highly Active Antiretroviral Therapies). Problems of health care coverage for HIV-infected patients reflect problems inherent in the current health care system. Introduction Although the rates of Human Immunodeficency Virus (HIV) infection and the Acquired Immunodeficency Syndrome (AIDS) in Utah are lower than the U.S. rates, it still remains an important cause of morbidity and mortality. This is especially true for men and women in the most productive years of their lives, aged 25-44. Among the states, the AIDS rate in Utah is in the second lowest quartile for men and the lowest quartile for women. Utah, like the rest of the western world, has seen a dramatic decrease in patients who progress from HIV positive to AIDS and death due to AIDS in the last two to three years. This is related to the new technologies and therapies which have become available. Currently, there is no seroprevalence data for 1998 for Utah. Unfortunately, ethical concerns called a halt to the gathering of this information as the positives would not be informed of their serostatus. The data that are available through counseling and testing sites suggest that the rates of positivity have decreased in 1997 and again in 1998. This data must be interpreted with caution considering the changing epidemiology of the disease and the lateness at which many of the patients present for care. The last report in Utah's Health was in 1995, prior to the introduction of viral load testing and drugs of the protease inhibitor class as well as other Highly Active Antiretroviral Therapies (HAART). In 1995, the numbers of deaths of AIDS patients peaked at 131 (Table 1). By 1996, with the advances in technology and a better understanding of the pathogenesis of the disease, leading to more effective therapies, the number of patients dying of the disease in Utah decreased to a total of 80, a decrease of 59%. These numbers decreased to only 44 deaths in 1997, a decrease of 45%, and further decreased to 26 deaths, a 41% decrease, in 1998. This downward trend in the number of AIDS deaths in Utah follows the national trend which shows a 42% decrease between 1996 and 1997. It is uncertain how long this trend can continue in the face of the national and local trends of clinical and virologic failure of therapies (Utah Department of Health, 1999; University of Utah Health Sciences AIDS Center, 1999). Trends in AIDS Deaths and Reporting The number of deaths is easier to track than the numbers of new or established infections in the population. Utah is a state that requires the reporting of both HIV infection and AIDS cases. There have been a cumulative total of 1,657 AIDS cases reported in Utah as of December 31,1998(UDOH, 1999). A total of 868 (52%) Utah AIDS cases have died. Thus, theoretically, as of December 31,1998, 792 AIDS cases diagnosed in Utah were alive. This number, however, does not account for the inward and outward migration of cases each year. The actual number of persons being cared for or living in the state without care is difficult to calculate. Early in the epidemic there was a definite inward migration of people with AIDS who were ill or who perceived themselves to be ill. Although there is no way to track this statistic, it appears that, as the patients are doing better, there is an increase of in and out migration, which may increase the number of patients being seen at different times in a year. Review of the data from the Infectious Disease clinic at the University suggests that the majority of the cases not followed locally have left the area (Practice Division of Infectious Diseases, 35 |