HIV infection in adolescents

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

An increasing number of HIV-infected children who acquired HIV infection through perinatal transmission are now surviving into adolescence. They generally have had a long clinical course and extensive ARV treatment history. Adolescents with behaviorally acquired infection (i.e., infection acquired via sexual activity or intravenous substance use) generally follow a clinical course similar to that in adults. Because behaviorally infected adolescents are at an early stage of HIV infection, they are potential candidates for early intervention and treatment.

Treatment

Dosing

• Many ARV medications (e.g., abacavir, emtricitabine, lamivudine, tenofovir, and some protease inhibitors [PIs]) are administered to children at higher weight- or surface area-based doses than would be predicted by direct scaling of adult doses, based upon reported PK data indicating more rapid drug clearance in children.
• Continued use of these pediatric weight- or surface area-based doses as a child grows during adolescence can result in medication doses that are higher than the usual adult doses.
• Many factors may affect the transition from pediatric to adult doses. In addition to toxicity, pill burden, adherence, and virologic and immunologic parameters, factors may include social determinants, such as housing, family support, employment, and recent discharge from the foster care system.

Specific issues in antiretroviral therapy for HIV-infected adolescents

Adolescent Contraception

• Adolescents with HIV infection, regardless of mode of acquisition, may be sexually active. Contraception methods and safer sex techniques for prevention of HIV transmission should be discussed with them regularly.
• Several PI and non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs interact with oral contraceptives, resulting in possible decreases in ethinyl estradiol or increases in estradiol or norethindrone levels.

Adolescent Pregnancy