Undiagnosed and unreported AIDS deaths: Results from the San Francisco Medical Examiner

To determine whether AIDS surveillance misses a substantial number of perso ns who die with unreported AIDS, we conducted a cross-sectional survey of d ecedents examined by the San Francisco (SF) Medical Examiner. Decedents who received toxicology screening were tested for HIV antibody and examined fo r evidence of AIDS. Names of decedents with positive or indeterminate HIV a ntibody test results were cross-referenced against the SF AIDS registry to identify previously reported AIDS cases. Medical records of unreported case s were reviewed to determine whether AIDS had been diagnosed prior to death . Of 1959 decedents tested, 176 (9%) were HIV positive; 105 (60%) were iden tified as having AIDS by the Medical Examiner. Of the 105 AIDS cases, 101 ( 96%) had been previously diagnosed; 98 (97%) had been previously reported. Overall, diagnosis and reporting were 93% complete. HIV-infected decedents were more likely than those uninfected to be men and < 45 years old, and le ss likely to be Asian/Pacific Islander or Native American (p < .001). They were more likely to have died of suicide (p < .05) or drug abuse/overdose ( p < .001). In SF, AIDS case reporting is highly complete. Current surveilla nce activities, which identify cases from health care settings, are appropr iate. To decrease deaths among HIV-infected persons, suicide prevention and substance abuse treatment programs are needed.