HIV and Adolescents
Scope of the Problem
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 20 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 1997, 2,953 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 29 states that
conduct HIV case surveillance indicate that
among adolescents aged 13 through 19:
- 48
percent were male;
- 52
percent were female;
- 29
percent were white, not
Hispanic;
- 65
percent were black, not
Hispanic;
- 1
percent were Hispanic;
and
- less
than 1 percent were
Asian/Pacific Islander or
American Indian/Alaskan
Native.
Transmission
Almost all adolescents
recently infected with HIV are exposed to the
virus through sexual intercourse or injection
drug use. The June 1997 29-state HIV
surveillance data suggest that most
adolescent males are infected with HIV
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 most adolescent females who
are infected with HIV were exposed through
heterosexual contact and a small percentage
through injection drug use.
CDC studies conducted
every two years in high schools (grades nine
through 12) consistently indicate that
approximately two-thirds of the students have
had sexual intercourse by the twelfth grade;
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 AIDS
Clearinghouse 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
perinatally 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 teenagers,
the Pediatric AIDS Clinical Trials Group
(also funded by the National Institute of
Child Health and Human Development [NICHD])
has developed a study specifically designed
to appeal to adolescents.
The National Cancer
Institute (NCI) is conducting clinical
research trials for children and adolescents
on the NIH Campus in Bethesda, Md. Thirty
percent of the patients enrolled in these NCI
intramural studies are adolescents. The NCI
also has a major initiative to identify,
provide access to and enroll adolescents with
sexually acquired HIV infection into clinical
research trials through a community-based
clinic at the Hospital for Sick Children in
Washington, D.C. The clinic, named NE Place
("any place") by the teens,
provides comprehensive adolescent services,
including outreach, education and
comprehensive care. Adolescents must report
to NCI for enrollment, but then receive
follow-up care at the NE Place clinic.
Physicians who are interested in referring
patients for evaluation in any NCI programs
should contact the Referral Coordinator:
Susan
Sandelli, RN
HIV and AIDS
Malignancy Branch
National
Cancer Institute
(301)
402-1391/1387
e-mail:
sandells@pbmac.nci.nih.gov
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:
1-800-TRIALS-A
(1-800-874-2572)
(TDD/Deaf
Access)
1-800-243-7012
For federally approved
treatment guidelines on HIV/AIDS, call the
HIV/AIDS Treatment Information Service:
1-800-HIV-0440
(1-800-448-0440)
(TDD/Deaf
Access)
1-800-243-7012
Both services operate
from 9 a.m. to 7 p.m. Eastern Time, Monday
through Friday. Spanish-speaking specialists
are available.
To obtain information
specifically about clinical trials conducted
by the NIAID Intramural AIDS Research
Program, call 1-800-243-7644.
To obtain materials for
adolescents with HIV, or more information
about adolescents and HIV, contact the
National AIDS Clearinghouse at 1-800-458-5231
or 1-800-243-7012 (TDD/Deaf Access).
NIAID, a
component of the National Institutes of
Health, supports research on AIDS, malaria,
tuberculosis and other infectious diseases,
as well as allergies and immunology.
Prepared by:
Office of Communications
National Institute of Allergy and Infectious
Diseases
National Institutes of Health
Bethesda, MD 20892
Public Health
Service
U.S. Department of Health and Human Services
November 1997
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