What are the DHHS guidelines for antiretroviral therapy of HIV infection in adolescents?

Updated: Apr 18, 2019
  • Author: R Chris Rathbun, PharmD, BCPS (AQ-ID), AAHIVP; Chief Editor: John Bartlett, MD  more...
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Answer

Adolescents with HIV infection represent a heterogenous patient population. This population includes newly infected patients and long-term survivors who were infected perinatally or through blood products. Though adolescents were not included in the START or TEMPRANO studies, based on the findings from these studies, early ART is recommended in adolescents with HIV infection as well. [107, 108]  Regardless of the timing and mode of transmission (newly infected or perinatally acquired), utilizing the sexual maturity rating (SMR), also known as Tanner stage, is generally recommended when antiretroviral therapy is being considered. [8]  Adult treatment guidelines are usually appropriate in postpubertal adolescents (SMR IV or V), and pediatric guidelines are generally more appropriate for less sexually mature adolescents (SMR < III). [8] Close monitoring for efficacy and toxicity is imperative, regardless of the dosing schedule used to implement therapy. 

Studies have found high rates of transmitted drug resistance in younger patient populations infected through sexual transmission. [8] As such, baseline resistance testing in this patient population is imperative.

Adolescents often have a myriad of difficult psychosocial issues that affect their ability to adhere to antiretrovirals and other treatment recommendations. Employing a team based approach with extensive case management and potentially mental health providers may assist in achieving treatment goals. [8]


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