Seroprevalence of HIV in the US Household Population Aged 18-49 Years: The National Health and Nutrition Examination Surveys, 1999-2006

Objective: To monitor trends in HIV seroprevalence in the United States, HIV testing was included in the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006. Methods: From 1999 to 2006, 11,928 participants aged 18-49 years were tested for HIV antibody. Prevalence estimates were weighted to account for oversampling and nonresponse. Results: There were 67 HIV antibody-reactive individuals for a seroprevalence of 0.5% [95% confidence interval (CI) 0.3-0.6]. In the only age subgroup directly comparable between surveys (18-39 years), HIV seroprevalence remained constant from NHANES III (1988-1994) to NHANES 1999-2002 and 2003-2006. In NHANES 1999-2006, non-Hispanic blacks had significantly higher HIV seroprevalence (2.0%, 95% CI 1.5-2.7) compared with individuals in all other race/ethnic groups combined. Seroprevalence was also higher in each race/ethnic group among men who have sex with men (9.4% 95% CI 5.0-17.1), among persons who had detectable antibody to herpes simplex type-two (1.9% 95% CI 1.4-2.8), among those who had 50 or more lifetime sex partners (3.4%, 95% CI 1.7-6.7), and among those who never married (0.8%, 95% CI 0.5-1.3). Conclusions: In this household-based population, seroprevalence did not significantly change from NHANES III to NHANES 1999-2006. Non-Hispanic blacks had significantly higher prevalence of infection compared with other race/ethnic groups. Male-to-male sex and the presence of HSV-2 antibody were the strongest predictors of HIV infection.