HIV Infection in Adolescents
The AIDS (acquired immunodeficiency syndrome) epidemic among adolescents in the United States continues to be an increasing concern. The U.S. Centers for Disease Control and Prevention (CDC) reports that 4,219 cumulative cases of AIDS among adolescents, or children ages 13 through 19, were reported through June 2001. The number of adolescents living with HIV (human immunodeficiency virus) is estimated to be much higher. Data from the 36 states that conduct HIV case surveillance indicate that among adolescents ages 13 through 19:
- 43 percent were male
- 57 percent were female
- 25 percent were White, not Hispanic
- 67 percent were Black, not Hispanic
- 6 percent were Hispanic
- Less than 1 percent were Asian/Pacific Islander or American Indian/Alaskan Native
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 17 percent of all reported cases of AIDS in the United States occur in people between the ages of 20 and 29. HIV infection is the sixth leading cause of death in this age group.
Most adolescents recently infected with HIV are exposed to the virus through sexual intercourse. Through June 2001, HIV surveillance data suggest that more than one-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 one-half of all adolescent females who are infected with HIV were exposed through heterosexual contact and a very small percentage through injection drug use.
Results of a CDC study conducted every 2 years in high schools (grades 9 through 12) indicate that in 1999
- 65 percent of the students had had sexual intercourse by grade 12
- 58 percent reported using a condom during last sexual intercourse
- 16 percent had had more than four sex partners
Approximately one quarter of the 15 million cases of sexually transmitted diseases (STDs) reported in the United States each year 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 chlamydial infection, 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.
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
- Emphasizing the success of newly available treatments
The U.S. Department of Health and Human Services has developed 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 and Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection are available from the HIV/AIDS Treatment Information Service (see More Information)
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 that of other adolescents and long-term surviving adults. Health care providers should refer to the treatment guidelines for detailed information about the treatment of HIV-infected adolescents.
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 infection
- Prevent and treat the opportunistic infections and cancers associated with AIDS
- 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 children and adults affected with HIV, 812 (1.5 percent) were adolescents.
To encourage participation by more adolescents, NIAID has identified adolescent treatment as an area of emphasis for the new research agenda of the Pediatric AIDS Clinical Trials Group (PACTG). Funded by NIAID and the National Institute of Child Health and Human Development (NICHD), PACTG's adolescent treatment agenda focuses on
- Expanding PACTG's adolescent research to every PACTG site
- Studying the effects of treatment on acute and early infection
- Restoring immune function
- Promoting collaborations to assist in prevention research, including behavioral research
Another resource for adolescent research is NICHD's Adolescent Medicine Trials Network (ATN). The ATN collaborates closely with many of NIAID's clinical research networks in an effort to increase adolescent participation in HIV/AIDS research. For more information about ATN, contact:
Audrey Rogers, Ph.D.
National Institute of Child Health and Human Development
For information about Food and Drug Administration-approved HIV-related clinical trials being conducted throughout the United States, contact the
AIDS Clinical Trials Information Service.
1-888-480-3739 (TTY/Deaf Access)
For federally approved treatment guidelines on HIV/AIDS, contact the
HIV/AIDS Treatment Information Service.
1-888-480-3739 (TTY/Deaf Access)
Both services operate from 12 p.m. to 5 p.m. Eastern Time, Monday through Friday. Spanish-speaking specialists are available.
For information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov).
NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.
Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
U.S. Department of Health and Human Services