May 2004

HIV Infection in Adolescents and Young Adults

OVERVIEW

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

Approximately 25 percent of cases of sexually transmitted infections (STIs) reported in the United States each year are among teenagers. This is particularly significant because the risk of HIV transmission increases substantially if either partner is infected with an STI. Discharge of pus and mucus as a result of STIs such as gonorrhea or chlamydia infection also increase the risk of HIV transmission three- to five-fold. Likewise, STI-induced ulcers from syphilis or genital herpes increase the risk of HIV transmission nine-fold.

TREATMENT

• 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.

CLINICAL TRIALS

• Prevent HIV infection
• Discover new therapies to improve control of viral replication in patients with HIV/AIDS
• Prevent and treat co-infections and cancers associated with AIDS
• Prevent and treat complications of HIV therapies
• Reconstitute HIV-damaged immune systems

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

MORE INFORMATION

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, 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

NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
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

Department of Health and Human Services

National Institutes of Health (NIH) Bethesda, Maryland 20892

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