The AIDS epidemic among adolescents and young adults in the United States continues to be an increasing concern. The Centers for Disease Control and Prevention (CDC) reported 41,287 cumulative cases of AIDS among people ages 13 through 24 through December 2002. Health experts estimate the number living with HIV (human immunodeficiency virus) infection to be much higher.

Because the average duration from HIV infection to the development of AIDS is 10 years, most adults with AIDS were likely infected as adolescents or young adults. HIV infection is the seventh leading cause of death for those ages13 through 24.

EXPOSURE AND TRANSMISSION

Adolescents and young adults tend to think they are invincible, and therefore, deny any risk. This belief may cause them to engage in risky behavior, delay HIV testing, and if they test positive, 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 providers may be able to help these adolescents and young adults understand their situation during visits by:

• Ensuring confidentiality
• Explaining the information clearly
• Eliciting questions
• Emphasizing the success of newly available treatments

According to the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, adolescents 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. Most adolescents with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention that includes education and counseling, identifying high-risk behaviors, and recommended therapies and behavioral changes.

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 adults. Health care providers should refer to the treatment guidelines for detailed information about the treatment of HIV-infected adolescents.

TREATMENT

Adolescents and young adults tend to think they are invincible, and therefore, deny any risk. This belief may cause them to engage in risky behavior, delay HIV testing, and if they test positive, 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 providers may be able to help these adolescents and young adults understand their situation during visits by Ensuring confidentiality Explaining the information clearly Eliciting questions Emphasizing the success of newly available treatments The U.S. Department of Health and Human Services (DHHS) 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 AIDSinfo http://aidsinfo.nih.gov/guidelines.

According to the Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, adolescents 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. Most adolescents with sexually acquired HIV are in a relatively early stage of infection and are ideal candidates for early intervention that includes education and counseling, identifying high-risk behaviors, and recommended therapies and behavioral changes.

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 adults. Health care providers should refer to the treatment guidelines for detailed information about the treatment of HIV-infected adolescents. (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.

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:

Recruiting adolescents and young adults 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 and young adults, but in reality very few enroll. Of the nearly 11,000 participants in studies conducted by the NIAID-supported Adult and Pediatric AIDS Clinical Trials Groups in Fiscal Year 2003, only 4.1 percent of the participants were adolescents (age 13-19).

To encourage participation by more adolescents and young adults, NIAID has identified adolescent treatment as an area of emphasis for the Pediatric AIDS Clinical Trials Group (PACTG). Funded by NIAID and the National Institute of Child Health and Human Development (NICHD), the PACTG's adolescent treatment research agenda focuses on:

• Expanding and enhancing adolescent research at all PACTG sites
• Engaging youth in treatment research opportunities
• Studying the effects of treatment on acute and early infection
• Restoring immune function
• Strengthening and augmenting long-term follow-up studies of safety and clinical effectiveness of antiretroviral therapies

Promoting collaborations to assist in prevention research Another major resource for adolescent research is NICHD's Adolescent Medicine Trials Network (ATN). The ATN collaborates closely with many of NIAID's clinical research networks, and particularly with the PACTG, in an effort to increase adolescent participation in HIV/AIDS research. For more information about the ATN, contact:
Audrey Rogers, Ph.D.
National Institute of Child Health and Human Development
301-496-7339

AIDSinfo is a comprehensive resource for up-to-date information on government and industry sponsored HIV/AIDS treatment and prevention clinical trials. AIDSinfo also maintains the most current, federally approved guidelines for treating and preventing HIV/AIDS in adults, adolescents, and children, for AIDS-related illnesses, for managing occupational exposure to HIV, and for preventing HIV transmission from mother-to-child during pregnancy.

AIDSinfo is sponsored by the NIH Office of AIDS Research, NIAID, National Library of Medicine, CDC, Health Resources and Service Administration, and Centers for Medicare and Medicaid Services.

AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
1-800-HIV-0440 (1-800-448-0440)
301-519-0459
1-888-480-3739 (TTY/TDD)
Monday to Friday, 12:00 p.m. to 5:00 p.m. Eastern Time http://aidsinfo.nih.gov

For information specifically about clinical trials conducted by the NIAID Intramural AIDS Research Program, call 1-800-243-7644 (http://clinicaltrials.gov)

REFERENCES FOR STATISTICS

CDC HIV/AIDS Surveillance Report, Vol. 14, December 2002 http://www.cdc.gov/hiv/stats/hasr1402.htm

CDC, Tracking the Hidden Epidemics Trends in STDs in the United States 2000

http://www.cdc.gov/nchstp/dstd/Stats_Trends/Trends2000.pdf

CDC Youth Risk Behavior Surveillance-United States, 2001. MMWR; June 21, 2002;51(SS04);1-64. MMWR: YRBS Surveillance Summary

Last updated April 27, 2005