HIV Infection in Adolescents

Overview

The human immunodeficiency virus (HIV), which causes AIDS, ranks seventh among the leading causes of death for U.S. children 5 to 14 years of age and sixth for young people 15 to 24 years of age. Because the average period of time from HIV infection to the development of AIDS is 10 years, most young adults with AIDS were likely infected with HIV as adolescents. Almost 18 percent of all reported cases of AIDS in the United States have occurred in people between the ages of 20 and 29.

In the United States, through June 1999, 3,564 cases of AIDS in people aged 13 through 19 had been reported to the Centers for Diseases Control and Prevention (CDC). Many other adolescents are currently infected with HIV but have not yet developed AIDS. Data from the 31 states that conduct HIV case surveillance indicate that among adolescents aged 13 through 19:

• 46 percent were male,

• 54 percent were female,

• 28 percent were non-Hispanicwhite,

• 66 percent werenon-Hispanic black,

• 5 percent were Hispanic, and

• less than 1 percent were Asian/Pacific Islander or American Indian/Alaskan Native.

Transmission

Most adolescents recently infected with HIV are exposed to the virus through sexual intercourse or injection drug use. Through June 1999, HIV surveillance data suggest that nearly half of all HIV-infected adolescent males are infected through sex with men. A small percentage of males appear to be exposed by injection drug use and/or heterosexual contact. The same data suggest that almost half of all adolescent females who are infected with HIV were exposed through heterosexual contact and a very small percentage through injection drug use.

CDC studies conducted every two years in high schools (grades nine through 12) consistently indicate that approximately 60 percent of the students have had sexual intercourse by grade 12; half report use of a latex condom during last sexual intercourse, and about one-fifth have had more than four lifetime sex partners.

Approximately two-thirds of the 12 million cases of sexually transmitted diseases (STDs) that are reported in the United States each year are in individuals under the age of 25 and one-quarter are among teenagers. This is particularly significant because if either partner is infected with another STD, the risk of HIV transmission increases substantially. If one of the partners is infected with an STD that causes the discharge of pus and mucus, such as gonorrhea or chlamydia, the risk of HIV transmission is three to five times greater. If one of the partners is infected with an STD that causes ulcers, such as syphilis or genital herpes, the risk of HIV transmission is nine times greater.

Treatment

Adolescents tend to think they are invincible, and therefore, to deny any risk. This belief may cause them to engage in risky behavior, to delay HIV-testing, and if they test positive, to delay or refuse treatment. Doctors report that many young people, when they learn they are HIV-positive, take several months to accept their diagnosis and return for treatment. Health care professionals may be able to help these adolescents by explaining the information slowly and carefully, eliciting questions from them, and emphasizing the success of newly available treatments.

The Department of Health and Human Services (DHHS) has developed three documents that address the standard of care for the treatment of HIV, including information about how to treat HIV in adolescents. The documents, Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection, and Report of the NIH Panel to Define Principles of Therapy of HIV Infection, are available from the National Prevention Information Network and the HIV/AIDS Treatment Information Service (telephone numbers are listed in the resources section). These documents also can be downloaded from the Internet at http://www.hivatis.org.

According to the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, adolescents who were exposed to HIV sexually or via injection drug use appear to follow a clinical course that is more similar to HIV disease in adults than in children. At this time, most adolescents with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention. Adolescents who were infected at birth or via blood products as young children follow a unique clinical course that may differ from other adolescents and long-term surviving adults. Physicians should refer to the treatment guidelines for detailed information about the treatment of HIV-infected adolescents.

In addition, the Adolescent Medicine HIV/AIDS Research Network, a collaborative effort between the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA), plans to publish a monograph called "Therapeutic Regimens Encouraging Adherence in Teens (TREAT)." This document will propose disease management strategies that incorporate the DHHS treatment recommendations and are tailored to adolescents.

Clinical Trials

The National Institute of Allergy and Infectious Diseases (NIAID) supports clinical trials at many clinics and medical centers throughout the United States. These studies help evaluate promising therapies to fight HIV infections, prevent and treat the opportunistic infections and cancers associated with AIDS, and reconstitute HIV-damaged immune systems.

Recruiting adolescents into clinical trials is important to ensure that research results will be applicable to therapy for that age group. Most clinical trials are open to adolescents, but in reality very few enroll. Of the 53,000 participants in studies conducted in the NIAID-supported AIDS Clinical Trials Groups, for pediatric and adult HIV-infected people, 812 (1.5 percent) were adolescents. To encourage participation by more adolescents , the Pediatric AIDS Clinical Trials Group (also funded by the National Institute of Child Health and Human Development [NICHD]) has developed an Adolescent Initiative to fund a research agenda on clinical studies relevant to HIV-infected youth.

The Adolescent Medicine HIV/AIDS Research Network was formed in 1994 to plan and conduct research on the medical, biobehavioral and psychosocial aspects of HIV and AIDS in young people. Funded by NIAID, NICHD, the National Institute on Drug Abuse (NIDA), the National Institute of Mental Health (NIMH), and HRSA, the network is currently recruiting participants for a study called REACH (Reaching for Excellence in Adolescent Care and Health). Researchers will learn about disease progression in adolescents by examining a number of immunological and virological factors. The goal is to enroll at least 360 high-risk, HIV-infected and HIV-uninfected adolescents. The results of this study are expected to assist researchers and policy makers in developing the agenda for future adolescent clinical trials. REACH is a national, observational study that is being conducted in 16 sites in 13 cities. Participants must be between the ages of 12 and 18, have a healthcare provider, and have been infected through sexual contact or injection drug use. To enroll a patient or obtain more information, physicians may call:

Audrey Rogers, Ph.D.
National Institute of Child Health
and Human Development
(301) 496-7339

Other Resources

For information about FDA-approved HIV-related clinical trials being conducted throughout the United States, call the AIDS Clinical Trials Information Service:

Recommended Books:
The Transforming Power of Illness: Healing Through AIDS by William Michael Kaufman
AIDS : Why Should I Care! Teens Across America Speak Out by Robert Starr
Understanding Hiv and AIDS by Robert A. Lue

Source:  National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, May 2000