Although the number of adolescents with diagnosed AIDS in the United States remains less than 1000, many more have HIV infection that has not yet manifested as clinical illness. In addition, most adolescents are involved in risk behaviors that potentially expose them to the virus. Medical providers should be prepared to identify those at highest risk and be familiar with the legal and ethical issues surrounding the evaluation and testing for HIV infection in this population of teenagers. HIV prevention and the presence of infection during pregnancy are particularly challenging to the provider in light of the special developmental and social issues that are inherent to the process of adolescence.
PIP: Almost 1200 adolescents were reported as having AIDS in the US as of March 1993. Although adolescents comprise only 1% of the total number of individuals with reported AIDS in the US, the most rapid increase in cases is occurring within this subpopulation. It is also the fastest growing subpopulation of HIV-infected individuals. Although the exact prevalence of HIV infection among adolescents is not known, the number of individuals infected with HIV is definitely far greater than the number of adolescents with AIDS. HIV seroprevalence rates in adolescents have ranged from 0.34/1000 among applicants for US military service under age 20 over 1985-89, to 2/1000 college students across the country, and 22/1000 adolescents at an inner-city STD clinic. The incubation period in adults from the time of initial HIV infection to the development of symptomatic AIDS is approximately ten years. 20% of people with AIDS are aged 20-29 years. The long incubation period therefore makes it highly likely that these latter individuals with AIDS were infected as teenagers or younger. This article addresses the epidemiology of HIV infection in adolescents, transmission issues, risk behaviors, testing, prevention, and pregnancy, and stresses the need for greater attention to HIV infection and AIDS in adolescents. Health care providers can use interview and counseling techniques to determine whether young people need to be evaluated for possible HIV infection and provide anticipatory guidance aimed at decreasing the risk of all adolescents. Such an approach would also certainly benefit pregnant women and their fetuses.