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HIV Infection in Adolescents

May 2003

Overview

The AIDS 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 4,428 cumulative cases of AIDS among adolescents, ages 13 through 19, were reported through December 2001. The number of adolescents living with HIV (human immunodeficiency virus) infection is estimated to be much higher. Data from the 36 states that conduct HIV case surveillance indicate that among adolescents ages 13 through 19

  • 58 percent were male
  • 42 percent were female
  • 27 percent were White, not Hispanic
  • 51 percent were Black, not Hispanic
  • 21 percent were Hispanic
  • Less than 21 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. HIV infection is the sixth leading cause of death in this age group.


Transmission

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Most adolescents recently infected with HIV are exposed to the virus through sexual intercourse. Through December 2001, HIV surveillance data suggest that 51 percent 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 49 percent 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 in 2001 in high schools (grades 9 through 12) indicate that

  • 61 percent of the students had had sexual intercourse by grade 12
  • 58 percent reported using a condom during last sexual intercourse
  • 14 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.


Treatment

Adolescents 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 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 (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 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

  • 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 nearly 10,000 participants in studies conducted by the NIAID-supported Adult and Pediatric AIDS Clinical Trials Groups in Fiscal Year 2002, 402 were adolescents affected with HIV.

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), the PACTG’s adolescent treatment 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, 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 the ATN, contact

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


More Information

AIDinfo is a comprehensive information and referral service that provides the most current information on federally and privately funded clinical trials for AIDS patients and others infected with HIV. AIDS clinical trials evaluate experimental drugs and other therapies for adults and children at all stages of HIV infection-from patients who are HIV positive with no symptoms to those with various symptoms of AIDS.

Web: http://aidsinfo.nih.gov
Telephone: 1-800-HIV-0440 (1-800-448-0440)
International: 301-519-0459
TTY/TDD: 1-888-480-3739
Email: ContactUs@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. 13, No.2, December
www.cdc.gov/hiv/stats/hasr1302.htm

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



  
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More Statistics on Young People and HIV/AIDS in the U.S.

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