It is interesting to review the 1987 CDC AIDS definition to be reminded how drastically this definition has been remodeled over the years. The most significant change has been to erase HIV negative AIDS from the CDC surveillance definition. Back in 1987 HIV-negative AIDS was still well defined by the CDC, as the flow diagram below makes clear. The rationale for revising the AIDS definition in 1987 is filled with contradictions:

The objectives of the revision are a) to track more effectively the severe disabling morbidity associated with infection with human immunodeficiency virus (HIV) (including HIV-1 and HIV-2); b) to simplify reporting of AIDS cases; c) to increase the sensitivity and specificity of the definition through greater diagnostic application of laboratory evidence for HIV infection; and d) to be consistent with current diagnostic practice, which in some cases includes presumptive, i.e., without laboratory evidence, diagnosis of AIDS-indicative diseases (e.g., Pneumocystis carinii pneumonia, Kaposi's sarcoma).

[...] The effectiveness of the revision will depend on how extensively HIV-antibody tests are used. Approximately one third of AIDS patients in the United States have been from New York City and San Francisco, where, since 1985, less than 7% have been reported with HIV-antibody test results compared with 60% in other areas.

[...] Clinicians will not rely on this definition alone to diagnose serious disease caused by HIV infection [...] For example, patients who are not reportable under the definition because they have either a negative HIV-antibody test or, in the presence of HIV antibody, an opportunistic disease not listed in the definition as an indicator of AIDS nonetheless may be diagnosed as having serious HIV-disease on consideration of other clinical or laboratory charracteristics of HIV infection or a history of exposure to HIV.

*Leads from the MMWR JAMA, Sept 4, 1987 - Vol 258, No.9, p. 1143.

TORONTO

HOME