Important note: Information in this article was accurate in May 1987. The state of the art may have changed since the publication date.Morbidity and Mortality Weekly Report - May 15, 1987 / 36(18);273-6
Centers for Disease Control and Prevention
Since October 1985, the U.S. Department of Defense has routinely tested civilian applicants for serologic evidence of infection with human immunodeficiency virus (HIV) as part of their preinduction medical evaluation (1). Results from the first 6 months of testing have been reported previously (2,3). Results for the first 15 months provide the opportunity to observe trends of infection in this population.
Between October 1985 and December 1986, 789,578 civilian applicants for military service were screened. Of these, 1,186 were confirmed as HIV-antibody positive by enzyme immunoassay and Western blot immunoelectrophoresis, for an overall rate of 1.5/1,000 individuals tested. Seroprevalence per 1,000 varied by age, sex, race and ethnicity, and region of residence. By age, it was 0.6 for 17-20 year-olds, 2.5 for 21-25 year-olds, and 4.1 for those greater than or equal to 26 years of age. By sex, it was 1.6 for males and 0.6 for females. By race and ethnicity, seroprevalence per 1,000 was 0.8 for whites, 4.1 for blacks, 2.3 for Hispanics, 1.0 for American Indians or Alaskan Natives and Asian or Pacific Islanders. Table 1 shows the seroprevalence among civilian applicants by region of residence.
During the 15-month observation period, the seroprevalence did not change significantly, either in the aggregate or when analyzed by age, sex, race and ethnicity (Figure 1), or geographic region. However, seroprevalence among white males showed a small but significant decline of 0.02/1,000 applicants tested per month (p = 0.016 by Chi Square test for trends in proportions using a logistic regression linear model). Reported by: Health Studies Task Force, Office of the Assistant Secretary of Defense (Health Affairs), US Dept of Defense, Washington, DC. Div of Preventive Medicine and Div of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Washington, DC. Surveillance and Evaluation Br, AIDS Program, Center for Infectious Diseases, CDC.
Editorial Note: AIDS cases reported to CDC continue to increase*. However, because of the lengthy incubation period of AIDS (4), these cases represent infection occurring at least several years prior to the report of disease. There has been little information to indicate current trends in HIV infection. Analysis of the results of the testing of civilian applicants thus far basically shows neither an increase nor a decrease in infection level for the group as a whole or for individual subgroups. The significance of this apparent absence of change in antibody prevalence during the 15-month period studied is not yet clear.
Volunteers for military service, who are verbally screened by the recruiting official prior to arrival at the medical evaluation center, are not fully representative of the overall population in that they underrepresent the three groups in the United States with the highest prevalence of HIV infection**. Moreover, applicants do not equally represent all socioeconomic and demographic groups in the population. A growing awareness of the military serologic screening program may have increased self-deferral by persons who are HIV-antibody positive or who feel they may have been exposed to the virus. If so, this could have masked an increased frequency of infection in the population from which the applicants are drawn.
Monitoring trends in infection among civilian applicants for military service as well as among blood donorsS remains important. It is also critical to compare trends in infection among these volunteer groups with similar trends among groups not affected by self-selection bias. One such surveillance approach, in which anonymously tested sample populations without AIDS-like disease are monitored at participating hospitals, has been initiated recently by CDC. Trends in exposure risks among seropositive individuals should also be monitored to assess possible changes in the relative frequency of the various modes of transmission. Follow-up interviews of a small number of seropositive applicants have found a high proportion with typical risk exposures for AIDS (5). CDC is collaborating with the U.S. Department of Defense, the National Cancer Institute of the National Institutes of Health, and certain state and local health departments to develop a systematic follow-up evaluation of seropositive civilian applicants in selected cities and states.
Herbold JR. AIDS policy development within the Department of Defense. Mil Med 1986 Dec;151(12):623-7.
CDC. Human T-lymphotropic virus type III/lymphadenopathy-associated virus antibody prevalence in U.S. military recruit applicants. MMWR 1986;35:421-4.
Burke DS, Brundage JF, Bernier W, et al. Demography of HIV infections among civilian applicants for military service in four counties in New York City: a preliminary analysis. New York State Med J (In press).
Lui KJ, Lawrence DN, Morgan WM, Peterman TA, Haverkos HW, Bregman DJ. A model-based approach for estimating the mean incubation period of transfusion-associated acquired immunodeficiency syndrome. Proc Natl Acad Sci U S A 1986 May;83(10):3051-5.
Stoneburner RL, Chiasson MA, Solomon K, Rosenthal S. Risk factors in military recruits positive for HIV antibody (Letter). N Engl J Med 1986 Nov 20;315(21):1355. *An average of 38.3 AIDS cases per day were reported for the period October-December 1986, compared with an average of 26.3 per day for the period October-December 1985. **Active intravenous drug abusers, homosexual men, and hemophiliacs. SLong-term data are not yet available for this group.
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