Transitioning HIV-Infected Adolescents Into Adult Care

Guideline and Commentary

Jacob Abadi, MD; Michael G. Rosenberg, MD, PhD


August 29, 2011

In This Article

Transitioning HIV-Infected Adolescents Into Adult Care: Guideline for Care

Editor's Note: This guideline was prepared and published by the New York State Department of Health AIDS Institute HIV Clinical Guidelines Program. It has been republished here. Please note that recommendations are assigned an evidence-based rating and use the rating scheme developed by the Department of Health and Human Services.


As HIV-infected adolescents grow into adulthood, it becomes necessary for them to transfer to adult care settings and take responsibility for their own health and disease management. Transition in this setting can be defined as "a multifaceted, active process thatattends to the medical, psychosocial, and academic or vocational needs of adolescents as theymove from the child- to the adult-focused healthcare system. Health care transition shouldalso facilitate transition in other areas of life as well (e.g., work, community, and school)."[1]

Adolescents and young adults are an increasing proportion of the HIV-infected population. In 2008, 17.6% of new HIV cases in New York State were in the 13- to 24-year-old age group. In addition, more perinatally infected patients have entered this age group. The HIV-infected adolescent population comprises a mixed group of 1) perinatally infected adolescents who are now surviving into adulthood, and 2) behaviorally infected adolescents, most of whom were infected sexually. Despite sharing some common characteristics, these two populations are quite distinct with respect to their needs and challenges.

The American Academy of Pediatrics defines adolescence as 13 to 21 years of age. The recommendations in this chapter pertain to both adolescents and young adults because many pediatric and adolescent clinicians follow HIV-infected patients from 13 to 24 years of age. For guidelines that focus on the comprehensive care of HIV-infected adolescents, refer to Ambulatory Care of HIV-Infected Adolescents .

These guidelines have been developed to assist providers with the transition process to ensure that HIV-infected young adults are successfully and seamlessly integrated into an adult care setting. Recommendations are meant to serve as a guide and will need to be tailored to the individual patient.

Table 1 lists the cornerstones of effective transitioning that are addressed in this chapter.

Table 1. General Principles for Effective Transitioning

  • Individualize the approach used

  • Identify adult care providers who are willing to care for adolescents and young adults

  • Begin the transition process early and ensure communication between the pediatric/adolescent and adult care providers prior to and during transition

  • Develop and follow an individualized transition plan for the patient in the pediatric/adolescent clinic; develop and follow an orientation plan in the adult clinic. Plans should be flexible to meet the adolescent's needs

  • Use a multidisciplinary transition team, which may include peers who are in the process of transitioning or who have transitioned successfully

  • Address comprehensive care needs as part of transition, including medical, psychosocial, and financial aspects of transitioning

  • Allow adolescents to express their opinions

  • Educate HIV care teams and staff about transitioning



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