The Topic of This Month Vol.25 No.7(No.293)
The numbers of HIV-infected persons without AIDS (hereafter abbreviated to HIV cases) and AIDS patients are based on the 2003 Annual Report confirmed on February 27, 2004 by the National AIDS Surveillance Committee. The Specific Disease Control Division, Ministry of Health, Labour and Welfare (MHLW) published this Report (see http://www.acc.go.jp/mlhw/mlhw_frame.htm).
1. The trend of HIV/AIDS incidence 1985-2003: HIV cases newly reported during 2003 counted at 640 (573 males and 67 females) and AIDS patients 336 (291 males and 45 females), both being the largest number ever reported (Fig. 1). Japanese males accounted for 82% of all HIV cases (76% in 2001 and 78% in 2002), and for 75% of all AIDS patients (67% in 2001 and 75% in 2002).
The cumulative number of reports (excluding those infected by use of coagulation factor products) from 1985 through December 31, 2003 counted at 5,780 for HIV cases and 2,892 for AIDS patients, corresponding to 4.554 for HIV cases and 2.279 for AIDS patients per 100,000 population. By a national survey independent of NESID, 1,432 HIV cases infected by use of coagulation factor products (including AIDS patients of 168 alive and 544 dead) were reported (as of May 31, 2002).
Nationality and gender: Of HIV cases, Japanese males markedly increased in 2003 and exceeded 500 for the first time attaining the highest number ever reported (Fig. 2). The number of cases of Japanese females and non-Japanese both genders have been keeping the same level for the past few years. As for AIDS patients, an increasing tendency of Japanese males is obvious, counting 252 in 2003, the largest number ever reported (Fig. 2).
Mode of infection and age distribution: In 2003, infection due to homosexual contacts was in the highest frequency for Japanese males ever reported for both HIV cases (340) and AIDS patients (91) (Fig. 3). The peak age of HIV cases infected by homosexual contact of Japanese males is at 25-29 years; increase in reports of 35-39 years is also marked (Fig. 4a). The age peak of HIV cases infected by heterosexual contact among Japanese males was not much different from that of the latter half of 20s through the first half of 50s in 2003 (Fig. 4b). It was anticipated that Japanese female cases were becoming younger; nevertheless no clear age peak was seen in 2003 (Fig. 4c). There were more female cases than male ones among Japanese HIV cases infected by heterosexual contact reported during 1999-2003 at the ages of 15-19 years (69%) and 20-24 years (54%), being largely different from other age groups (Fig. 5).
Intravenous drug abuse and mother-to-child infection accounts for less than 1% of either HIV cases or AIDS patients; six instances of intravenous drug abuse (four HIV cases and two AIDS patients), the largest number ever reported among Japanese cases, were reported in 2003. A case of mother-to-child infection of an AIDS patient was reported (no HIV case).
According to a survey for mother-to-child infection in Japan, annual births from HIV-infected pregnant women have counted at about 20 after 1998, showing a tendency of increase; the number of HIV infected children was peaked at seven in 1995 and is tended to decrease, showing that the mother-to-child infection-preventive measures were successful (see p. 171 of this issue).
Regions of acquiring infection/of reporting: The estimated regions of acquiring infection in 2003 were mostly within Japan for both HIV cases and AIDS patients (78% of HIV cases and 64% of AIDS patients). The regions of reporting were still mostly accumulated on the Kanto/Koshinetsu District (62% of HIV cases and 65% of AIDS patients). The prefectures in which there were many HIV cases (>=10) were, in the order of number of cases, Tokyo, Osaka, Kanagawa, Aichi, Chiba, Hyogo, Kyoto, Ibaraki, Shizuoka, Tochigi, Gunma, and Saitama. Reports are on the increase in Hiroshima and Okinawa Prefectures, although in very small number.
2. Deaths from AIDS: Deaths from AIDS before March 31,1999 counted at 596, of which 485 were Japanese (445 males and 40 females) and 111 non-Japanese (77 males and 34 females). Death cases reported to the Specific Disease Control Division, MHLW by the case-follow-up data for alive¨death reported voluntarily during the period from April 1999 through December 31, 2003 counted at 139 Japanese cases (130 males and nine females) and 31 non-Japanese (20 males and 11 females), totaling 170, of which those reported during 2003 counted at 19 in all, 15 of which were Japanese (15 males and no female) and four non-Japanese (four males and no female).
3. HIV-antibody-positive rate among blood donors: The HIV-antibody-positive rate of blood donors is on the yearly increase. In 2003, the antibody positives counted at 87 (79 males and eight females) of 5,621,096 donations, corresponding to 1.548 per 100,000 donations, which was more than that in 2002 and the highest ever reported (Fig. 6). To avoid donation of blood for the purpose of HIV testing, it is necessary to make it known to the people that the results of the HIV testing are not reported to the donors.
4. HIV testing and counseling at health centers: HIV-antibody testing and counseling at health centers in 2003 was on the increase from the preceding year. The HIV-antibody tests numbered 59,237 and counsels 130,153. At the Metropolitan Minami-Shinjuku HIV-testing & counseling Room, tests and positive cases are increasing due to the opening the window for free tests conducted on Saturdays and Sundays in addition to the weekday evenings (see p. 170 of this issue). The windows for tests on Saturdays, Sundays, and evenings or without reservation are open in many districts (refer to http://www.hivkensa.com/index.html).
For the convenient use of anonymous testing, the MHLW distributes to each prefecture the Guidelines for Instant HIV Testing at Health Centers and Other Places compiled by the Research Group for Construction of HIV-testing System headed by M. Imai (see http://api-net.jfap.or.jp/siryou/siryou_Frame.htm).
Conclusion: Both HIV cases and AIDS patients attained the largest number in 2003 and are still on the increase in Japan being quite different from the situation in Europe and the United States of America, where some brake is being applied on such increase. Infection among males by homosexual contact increased particularly in 2003, therefore, positive preventive measures are necessary for non-Japanese as well as for Japanese. For HIV cases infected by heterosexual contacts among young Japanese people, a large proportion of females are involved, calling more attention to young boys and girls is further required.
HIV cases and AIDS patients are on the increase in local big cities in addition to the Kanto District including Tokyo where HIV/AIDS are prevalent; development of measures in each district is desired. A plan for enlightening young people for counseling and tests acceptable anytime at more places will lead to early diagnosis and prevention of spreading infections.
Prognosis of HIV cases has recently been improved by progressed multi-drug therapy, nevertheless delayed diagnosis of HIV infection will cause turning to the worse, largely affecting the prognosis. As AIDS patients diagnosed and reported after development of the disease are still on the increase; propagation of testing for early diagnosis of HIV infection seems necessary.
Footnote
Reports of AIDS patients: These are reports of HIV cases with AIDS-defining disease already developed at diagnosis. They might not notice their HIV infection before development of AIDS.
Reports of HIV-infected: These are reports of those whose infection became clear by a chance (blood test, consultation of a hospital, or blood donation) after infection with HIV and before developing AIDS-defining disease, being 10 years on the average (see IASR Vol. 23, No. 5). Once reported as HIV-infected, they may not be reported as AIDS patients even developing AIDS-defining disease later (in this case, reported voluntarily as separate case-follow-up data for HIV¨AIDS). The number of HIV/AIDS reports, therefore, reflect the infection status during the past 10 years and the opportunity to receive HIV testing or medical consultation, not indicating the real-time infection status.
Case-follow-up data for alive¨death: If reported as AIDS patient and die later, the physician will report voluntarily the case-follow-up data.
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