HIV Screening, Testing and Treatment in Adolescents

January 2012

Meera Beharry, MD

Division of Adolescent MedicineUniversity of Rochester Medical Center

ACT for Youth Center of Excellence

Cornell University Bronfenbrenner Center for Translational Research Cornell University Cooperative Extension of New York CityNew York State Center for School SafetyUniversity of Rochester Medical Center Div. of Adolescent Medicine

ObjectivesDescribe current screening methodsUnderstand reasons why repeat testing

would be necessaryDiscuss treatment issues specific to

adolescents

Summary of HIV and AIDS (1 of 2)

HIV is acquired through direct contact with infected body fluids of a person who has HIV.

Untreated, HIV destroys the body’s immune system, leading to AIDS (serious infections, organ failure and death).

High-risk groups: Males who have sex with males at highest

risk. High-risk heterosexual activity is most

rapidly increasing cause.

Summary of HIV and AIDS (2 of 2)

Avoid high-risk behaviors to avoid HIV.Screening is reliable and results can be

obtained quickly; Testing takes longer but is definite.

Treatment with multiple medications (Highly Active Anti-Retroviral Therapy-HAART) is able to stop the progression of HIV replication in the body, but requires compliance with therapy.

HIV Time Course Without Treatment

Screening HIV screening is

recommended for patients in all health-care settings

Persons at high risk for HIV infection should be screened for HIV at least once a year.

Variety of methods

HIV Screening Tests

Uni-Gold FDA approved 2003 Uses small amount

of blood For use by

professionals only Results in 10

minutes Positive result must

be confirmed

Ora-Quick Advance ® Approved in 2002 Uses small amount

of blood or oral fluid For use by

professionals only Results in 20

minutes Positive results must

be confirmed

Home TestsFirst licensed in 1997Only the Home Access HIV-1® test

system is approved by FDA Is actually home collection kitMust call in for resultsExpensive

http://www.cdc.gov/hiv/topics/testing/resources/qa/tests_work.htm#screening

Need to retest

Confirmatory TestingMandatory for positive resultsWestern Blot

Blood draw Oral fluid

Follow-up in 4 weeks if “indeterminate” or negative

Treatment Highly Active Anti-

Retroviral Therapy (HAART)

Early, consistent treatment can prolong life

Can prevent spread to unborn child

PEP: Post Exposure Prophylaxis

“The patient’s need for HAART must be balanced with the ability to adhere to the drug regimen.”

Adolescent Health Care and Practical Guide Belzer and Neinstein

Medication Adherence Assessment Perception of Health Status Social Support Living arrangements/housing stability Psychological concerns Developmental Level Factors that influence ability to take

medication Time orientation and organization Physical abilities Tolerance of side effects Medication Complexity

Myerson, Alice: Adolescent AIDS Program @ Montefiore

Life Skills That an Adolescent Needs for Successful Transition to an Adult Clinic

Knowing when and how to seek medical care Knowing when and how to seek medical care for symptoms or emergenciesfor symptoms or emergencies

Using one’s primary care provider appropriatelyUsing one’s primary care provider appropriately Making, canceling, and rescheduling Making, canceling, and rescheduling

appointmentsappointments Coming to appointments on timeComing to appointments on time Calling ahead of time for urgent visitsCalling ahead of time for urgent visits Refilling of prescriptions on timeRefilling of prescriptions on time Maintenance of one’s health insurance Maintenance of one’s health insurance Negotiating multiple subspecialty providersNegotiating multiple subspecialty providers

Jeffrey M Birnbaum, MD,MPHSUNY Downstate Medical Center

Summary Everyone should be tested for HIV There are many options for HIV testing and

screening---young people may not be aware of these

A positive or indeterminate screening result must be verified with a more specific test

People at high risk for acquiring HIV should be tested at least once a year

SummaryEarly and appropriate treatment with

HAART makes it possible for people who are HIV positive to live healthy and productive lives

HIV positive individuals should be treated by specialists

Being able to adhere to a treatment plan is of utmost importance

Testing

NYS DOH HIV Counseling and Testing Resource Directory (11/10 Update)www.health.ny.gov/publications/9515/index.htm

NYS DOH phone Via the DOH

website below National info by

texting your zip code to KNOWIT (566948) or

www.HIVtest.org

http://www.hivtest.org/

Resources CDC: www.cdc.gov/hiv/ NYS DOH AIDS Institute:

http://www.nyhealth.gov/diseases/aids/ 100 questions and answers about HIV/AIDS

http://www.nyhealth.gov/publications/0213.pdf http://www.nyhealth.gov/publications/0214.pdf (Español)

NYC DOH/MH: www.nyc.gov/html/doh/html/ah/ah.shtml

Or call: 1-800-541-AIDS (English) 1-800-233-SIDA (Español) Complete HIV/AIDS & Young People Series:

http://actforyouth.net/hiv-series

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