Background:  Worldwide, most HIV infections result from heterosexual transmission; in the United States, a growing proportion of HIV/AIDS cases are attributed to heterosexual contact. Since the introduction of highly active antiretroviral therapy in the United States in 1996, persons with HIV have been living longer. The purpose of this analysis is to describe survival after a diagnosis of AIDS acquired through heterosexual contact.

Methods:  Using data from the national HIV/AIDS surveillance system, we analyzed AIDS cases diagnosed during 1996-2001 and reported to the Centers for Disease Control and Prevention through June 2003, including data on deaths that occurred through December 2002. We considered cases to have resulted from heterosexual contact if they were in persons who had had heterosexual contact with a sex partner known to be HIV-- infected or to be at increased risk for HIV infection (e.g. bisexual male, injection drug user) and had not themselves had male homosexual contact or injected drugs. We conduced Kaplan-Meier survival analyses on these data and present differences in survival that were significant at p<0.001 according to the log-rank test.

Results:  Of 269,212 cases of AIDS diagnosed during 1996-2001, 48,291 (18%) resulted from heterosexual contact. Of persons in this transmission category, the estimated proportion surviving more than 5 years after diagnosis was 77%, compared with 81% of men who had sex with men, 69% of injection drug abusers, and 75% of men who had sex with men and were injection drug users. Among persons with heterosexually acquired AIDS, the estimated proportion surviving more than 2 years increased from 83% in 1996 to 89% in 2000. The estimated proportion of persons with heterosexually acquired AIDS who survived more than 5 years was lowest for non-Hispanic blacks (74%), highest for non-Hispanic whites (82%), and intermediate for Hispanics (79%). Survival decreased with increasing age (by decade) at diagnosis among those older than 30 years. Survival was similar (77%) for women and men.

Conclusions:  In recent years, survival has improved after diagnosis of AIDS resulting from heterosexual transmission of HIV, but racial/ethnic disparities exist.

Keywords: Survival; AIDS; heterosexual contact