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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-Hispanic white,
- 66 percent were non-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
NIAID,
a component of the National Institutes of Health, supports research
on AIDS, tuberculosis and other infectious diseases as well as allergies
and immunology.
Reprinted
with permission from:
National Institute
of Allergy and Infectious Diseases
Office of Communications and Public Liaison
National Institutes of Health
Bethesda, MD 20892
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