In an effort to help stop the spread of HIV among teens, the American Academy of Pediatrics (AAP) now recommends routine screening for adolescents who live in certain high risk communities. In areas where more than 1 in every 1000 people is infected with the virus or the HIV prevalence is unknown, pediatricians should offer testing at least once to all teens between the ages of 16 to 18 regardless of sexual history. The advice is part of an updated policy statement published online October 31 in Pediatrics.
The new AAP policy expands 2001 recommendations that encouraged routine, targeted HIV testing of sexually active youth only. The call for expanded HIV screening comes in response to epidemiological data showing such targeted testing of teens hasn't been very successful in communities with high infection rates. Some states with higher prevalence rates include those in the northeast (e.g., New York, New Jersey) and the southeast (e.g., Florida, Georgia). (For more details, see the Centers for Disease Control and Prevention CDC web page, Map Based on Data from 2008 HIV Surveillance Report.) For areas with lower prevalence, the AAP continues to suggest testing for all sexually active teens and for those with other risk factors for HIV, such as intravenous drug use.
Studies cited in the policy statement show that in 2006, 48% of teens and young adults with HIV were unaware of their infection. In addition, the rate of new HIV diagnoses rises with age, from 12.6 per 100,000 population in youth 15 through 19 to 37.2 per 100,000 population in those 20 through 24.
Most young people do not think that they are at risk for HIV, even though sexually active. A 2009 survey cited in the policy found that 46% of high school students overall and 62% of 12th graders reported sexual activity. More than 85% of respondents reported receiving education about HIV/AIDS, but only 13% had been tested.
Also driving the policy change are advances in testing and federal recommendations. Less invasive rapid tests and oral tests make screening easier, although the gold standard remains HIV antibody tests on blood followed by confirmatory testing of positive screening results. The CDC recommendations issued in 2007 call for routine HIV testing for all teens age 16 or older and all adults through age 64 who are seen in health care settings, with provisions for opting out.
Teens who get tested for any sexually transmitted diseases should get HIV testing during the same visit, advises the AAP.
The policy also recommends that:
- Youth at high risk of HIV – including intravenous drug users and men who have sex with men – should get annual tests for the virus.
- Doctors should be aware of and recognize the symptoms of the first stage of HIV infection, called acute retroviral syndrome, which may resemble symptoms of the flu. Signs and symptoms should prompt consideration of HIV RNA testing in the diagnostic workup of youth when HIV antibody tests are negative but the appropriate risk factors are present. (Another option would be to use a combination test that detects both HIV antibody and antigen.)
- Doctors with patients who test positive for HIV must refer patients to age-appropriate HIV specialty care, including prenatal care when appropriate.
- Pediatricians should take the opportunity to discuss sexual and drug use behavior with teens who test negative.
- The teen's consent should be sufficient to provide testing for HIV and other sexually transmitted diseases.
- Urgent care centers and emergency departments in communities with high HIV prevalence rates should implement routine HIV testing.
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Emmanuel PJ, et al. Adolescents and HIV infection: The pediatrician's role in promoting routine testing. Pediatrics 2011; 128: 1023–1029. Available online at http://pediatrics.aappublications.org/content/early/2011/10/26/peds.2011-1761.abstract through http://pediatrics.aappublications.org. Published online October 31, 2011. Accessed December 8, 2011.
Michael Smith. Medical News: AAP Backs HIV Tests for Teens. MedPage Today. Available online through http://www.medpagetoday.com. Published October 31, 2011. Accessed December 8, 2011.
Christine S. Moyer. HIV testing recommended for teens and young adults. American Medical News. Available online at http://www.ama-assn.org/amednews/2011/11/14/hlsa1114.htm through http://www.ama-assn.org. Published November 14, 2011. Accessed December 8, 2011.