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Estimation of HIV Incidence in the United States
Journal of the American Medical Association (2008)
  • Irene Hall, Centers for Disease Control
  • R Song, Centers for Disease Control
  • P Rhodes, Centers for Disease Control
  • John Karon
  • Ron Brookmeyer, Johns Hopkins Bloomberg School of Public Health
  • Edward Kaplan, Yale University
  • M McKenna, Centers for Disease Control and Prevention
  • R Janssen
  • HIV Incidence Surveillance Group

Context: Incidence of human immunodeficiency virus (HIV) in the United States has not been directly measured. New assays that differentiate recent vs long-standing HIV infections allow improved estimation of HIV incidence.

Objective: To estimate HIV incidence in the United States.

Design, Setting, and Patients : Remnant diagnostic serum specimens from patients 13 years or older and newly diagnosed with HIV during 2006 in 22 states were tested with the BED HIV-1 capture enzyme immunoassay to classify infections as recent or long-standing. Information on HIV cases was reported to the Centers for Disease Control and Prevention through June 2007. Incidence of HIV in the 22 states during 2006 was estimated using a statistical approach with adjustment for testing frequency and extrapolated to the United States. Results were corroborated with back-calculation of HIV incidence for 1977-2006 based on HIV diagnoses from 40 states and AIDS incidence from 50 states and the District of Columbia.

Main Outcome Measure : Estimated HIV incidence.

Results: An estimated 39 400 persons were diagnosed with HIV in 2006 in the 22 states. Of 6864 diagnostic specimens tested using the BED assay, 2133 (31%) were classified as recent infections. Based on extrapolations from these data, the estimated number of new infections for the United States in 2006 was 56 300 (95% confidence interval [CI], 48 200-64 500); the estimated incidence rate was 22.8 per 100 000 population (95% CI, 19.5-26.1). Forty-five percent of infections were among black individuals and 53% among men who have sex with men. The back-calculation (n = 1.230 million HIV/AIDS cases reported by the end of 2006) yielded an estimate of 55 400 (95% CI, 50 000-60 800) new infections per year for 2003-2006 and indicated that HIV incidence increased in the mid-1990s, then slightly declined after 1999 and has been stable thereafter.

Conclusions: This study provides the first direct estimates of HIV incidence in the United States using laboratory technologies previously implemented only in clinic-based settings. New HIV infections in the United States remain concentrated among men who have sex with men and among black individuals.

Publication Date
Citation Information
Irene Hall, R Song, P Rhodes, John Karon, Ron Brookmeyer, Edward Kaplan, M McKenna, R Janssen, and HIV Incidence Surveillance Group. "Estimation of HIV Incidence in the United States" Journal of the American Medical Association 300 (2008): 520-529.