HIV testing recommended for teens and young adults
■ New AAP guidance encourages pediatricians to know the symptoms of early-stage HIV and openly discuss sexual activity and other STDs with patients.
By Christine S. Moyer — Posted Nov. 14, 2011
Despite the nation's progress in reducing HIV infections, the illness increasingly is being reported among people 13 to 29 years old, according to the Centers for Disease Control and Prevention. Contributing to the rise is the growing number of new HIV cases in young men who have sex with other males, the CDC says.
In an effort to reduce infections in this age group, the American Academy of Pediatrics recommends that pediatricians routinely test their adolescents patients for HIV. Physicians should offer the test at least once to all patients between the ages of 16 and 18 in communities where more than .1% of the population is infected with the virus, the AAP says.
In areas of lower community HIV prevalence, doctors should test at least once a year all sexually active adolescents and those with other HIV risk factors. Such risk factors include intravenous drug use, exchanging sex for money, having a sexually transmitted infection and being a man who has sex with other males.
The AAP policy statement, published online Oct. 31 in Pediatrics, updates the academy's 2000 guidance that physicians test only those patients considered at risk of contracting the infection.
"HIV testing only people in groups we thought to be at risk was not effective in reducing the epidemic, particularly among young people," said Jaime Martinez, MD, second lead author of the policy statement and an adolescent medicine specialist at Stroger Hospital of Cook County in Chicago.
"By pediatricians offering routine testing, more and more of these youths with HIV will become aware of their infection and be able to avail themselves of present treatment," said Dr. Martinez, associate professor of pediatrics at the University of Illinois at Chicago.
Some unaware of infection
At the end of 2008, an estimated 1.2 million people 13 and older were living with HIV in the United States, the CDC said. Of those infected, 5.8% were adolescents and young adults 13 to 24. People in that age group were the least likely to know they were infected, with more than half unaware they had HIV, CDC data show.
To help ensure that HIV cases are not overlooked, the AAP encourages physicians to regularly screen patients for sexual activity and substance use. Pediatricians also are urged to know the symptoms of the early stages of HIV infection, which include diarrhea, fever, influenza-like illness, mononucleosis symptoms and skin rash.
Early treatment dramatically reduces the risk of transmitting the infection through sexual activity, say HIV/AIDS medicine specialists.
The AAP policy recommends that pediatricians use a negative test result as an opportunity to educate patients about how to prevent contracting the illness. Positive results should be given to patients in person, and the pediatrician should link the youth to local support systems and specialty care, the AAP says.
The academy urges physicians to create a tolerant environment at their practices by openly discussing sexual activity, HIV and other sexually transmitted diseases.
Dr. Martinez recommends that doctors place information about HIV in their waiting rooms and hang educational posters on HIV on their walls.
"This is a way of letting youth know that it's OK to discuss this subject, and it [highlights] the importance of testing," he said.