The adolescent with HIV infection
- Susan L Gillespie, MD, PhD
Susan L Gillespie, MD, PhD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Mary E Paul, MD
Mary E Paul, MD
- Section Editor — Pediatric HIV Infection
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Associate Professor of Pediatrics
- University of Massachusetts Medical School
Exposure to human immunodeficiency virus (HIV) can be a consequence of many of the risk-taking behaviors that occur among adolescents. Efforts to improve adolescent health through access to diagnosis, treatment, and prevention education must take into account the developmental level of the patient, as well as social and psychological variables.
Issues surrounding HIV infections vary widely between adolescents in developing countries and those in the developed world. This topic will principally review, within the developed world, the epidemiology of and risk factors for HIV infection among adolescents, strategies to provide services to adolescents, and age-specific recommendations for initiating treatment. The epidemiology, natural history, and classification of pediatric HIV infection are discussed separately. (See "Epidemiology of pediatric HIV infection" and "Natural history and classification of pediatric HIV infection".)
There are unique challenges to the prevention, diagnosis, and treatment of HIV infection among adolescents. A comprehensive program for adolescents at risk for human immunodeficiency virus (HIV) infection must include efforts at preventing infection (such as outreach programs), easily accessible testing, and counseling. Programs that have been successful are peer oriented and target specific high-risk behaviors [1,2].
The Centers for Disease Control and Prevention (CDC) provides guidelines for HIV counseling, testing, and referral . Specific issues that should be addressed with adolescents include the following:
●Reason for testing – The adolescent who has recently engaged in a high-risk activity must understand the importance of retesting in six months. Some teens have already had a positive test and are seeking confirmation.
- Futterman DC, Peralta L, Rudy BJ, et al. The ACCESS (Adolescents Connected to Care, Evaluation, and Special Services) project: social marketing to promote HIV testing to adolescents, methods and first year results from a six city campaign. J Adolesc Health 2001; 29:19.
- Woods ER. Overview of the Special Projects of National Significance Program's 10 models of adolescent HIV care. J Adolesc Health 1998; 23:5.
- Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55:1.
- Futterman DC. HIV and AIDS in adolescents. Adolesc Med Clin 2004; 15:369.
- Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2003. 15:6.
- Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2008. 17:1.
- Centers for Disease Control and Prevention (CDC). Vital signs: HIV infection, testing, and risk behaviors among youths - United States. MMWR Morb Mortal Wkly Rep 2012; 61:971.
- CDC. HIV surveillance in adolescents and young adults. http://www.cdc.gov/hiv/topics/surveillance/resources/slides/adolescents/index.htm (Accessed on June 13, 2011).
- Wilson CM, Houser J, Partlow C, et al. The REACH (Reaching for Excellence in Adolescent Care and Health) project: study design, methods, and population profile. J Adolesc Health 2001; 29:8.
- Centers for Disease Control and Prevention (CDC). Trends in HIV/AIDS diagnoses among men who have sex with men--33 states, 2001-2006. MMWR Morb Mortal Wkly Rep 2008; 57:681.
- Centers for Disease Control and Prevention (CDC). HIV infection among young black men who have sex with men--Jackson, Mississippi, 2006-2008. MMWR Morb Mortal Wkly Rep 2009; 58:77.
- Bingham TA, Harawa NT, Johnson DF, et al. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men's Survey, Los Angeles, 1999-2000. AIDS Educ Prev 2003; 15:39.
- Abrams EJ, Weedon J, Bertolli J, et al. Aging cohort of perinatally human immunodeficiency virus-infected children in New York City. New York City Pediatric Surveillance of Disease Consortium. Pediatr Infect Dis J 2001; 20:511.
- Chabon B, Futterman D, Hoffman ND. HIV infection in parents of youths with behaviorally acquired HIV. Am J Public Health 2001; 91:649.
- Newbern EC, Anschuetz GL, Eberhart MG, et al. Adolescent sexually transmitted infections and risk for subsequent HIV. Am J Public Health 2013; 103:1874.
- Grant AM, Jamieson DJ, Elam-Evans LD, et al. Reasons for testing and clinical and demographic profile of adolescents with non-perinatally acquired HIV infection. Pediatrics 2006; 117:e468.
- Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 U.S. Dependent Areas—2010. http://www.cdc.gov/hiv/surveillance/resources/reports/2010supp_vol17no3/index.htm (Accessed on December 20, 2012).
- D'Angelo LJ, Samples C, Rogers AS, et al. HIV infection and AIDS in adolescents: an update of the position of the Society for Adolescent Medicine. J Adolesc Health 2006; 38:88.
- Committee on Pediatric AIDS, Emmanuel PJ, Martinez J. Adolescents and HIV infection: the pediatrician's role in promoting routine testing. Pediatrics 2011; 128:1023.
- American Academy of Pediatrics. Human immunodeficiency virus infection. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.453.
- Kamb ML, Fishbein M, Douglas JM Jr, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA 1998; 280:1161.
- Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997. Am J Public Health 1999; 89:1397.
- Pao M, Lyon M, D'Angelo LJ, et al. Psychiatric diagnoses in adolescents seropositive for the human immunodeficiency virus. Arch Pediatr Adolesc Med 2000; 154:240.
- Futterman D, Stafford SR, Madhava V. To test or not to test is no longer the question: time to ACTS (assess, consent, test, support). a rapid new paradigm [abstract M2-C0803]. In: Proceedings and abstracts of the 2003 National HIV Prevention Conference, Atlanta 2003. Atlanta, GA.
- Rudy BJ, Murphy DA, Harris DR, et al. Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: a study of prevalence and interactions. AIDS Patient Care STDS 2009; 23:185.
- Aberg JA, Gallant JE, Ghanem KG, et al. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis 2014; 58:e1.
- Martinez J, Chakraborty R, American Academy of Pediatrics Committee on Pediatric Aids. Psychosocial support for youth living with HIV. Pediatrics 2014; 133:558.
- Rogers AS, Miller S, Murphy DA, et al. The TREAT (Therapeutic Regimens Enhancing Adherence in Teens) program: theory and preliminary results. J Adolesc Health 2001; 29:30.
- Rotheram-Borus MJ, Miller S. Secondary prevention for youths living with HIV. AIDS Care 1998; 10:17.
- Catania JA, Kegeles SM, Coates TJ. Towards an understanding of risk behavior: an AIDS risk reduction model (ARRM). Health Educ Q 1990; 17:53.
- Lyon ME, Trexler C, Akpan-Townsend C, et al. A family group approach to increasing adherence to therapy in HIV-infected youths: results of a pilot project. AIDS Patient Care STDS 2003; 17:299.
- Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363:2587.
- Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 2010; 329:1168.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Swan AM, Daley AM, Crowley A. Contraceptive counseling for adolescents with HIV. Nurse Pract 2007; 32:38.
- Storm DS, Boland MG, Gortmaker SL, et al. Protease inhibitor combination therapy, severity of illness, and quality of life among children with perinatally acquired HIV-1 infection. Pediatrics 2005; 115:e173.
- Lee CL, Johann-Liang R. Disclosure of the diagnosis of HIV/AIDS to children born of HIV-infected mothers. AIDS Patient Care STDS 1999; 13:41.
- Butler AM, Williams PL, Howland LC, et al. Impact of disclosure of HIV infection on health-related quality of life among children and adolescents with HIV infection. Pediatrics 2009; 123:935.
- Mellins CA, Smith R, O'Driscoll P, et al. High rates of behavioral problems in perinatally HIV-infected children are not linked to HIV disease. Pediatrics 2003; 111:384.
- Tassiopoulos K, Moscicki AB, Mellins C, et al. Sexual risk behavior among youth with perinatal HIV infection in the United States: predictors and implications for intervention development. Clin Infect Dis 2013; 56:283.
- DiClemente RJ, Wingood GM, Harrington KF, et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA 2004; 292:171.
- Jemmott JB 3rd, Jemmott LS, Braverman PK, Fong GT. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med 2005; 159:440.
- RISK FACTORS
- COUNSELING AND TESTING
- Pre-test counseling
- - Reason for testing
- - Comorbidities and resources
- - Privacy
- - Prevention
- Post-test counseling
- EVALUATION OF THE HIV-POSITIVE ADOLESCENT
- Psychosocial evaluation
- Physical examination and laboratory testing
- Increasing compliance and general counseling
- Antiretroviral therapy
- - Medication dosing
- Condom use
- VERTICALLY INFECTED ADOLESCENTS
- SUMMARY AND RECOMMENDATIONS