HIV Screening, Testing and
Treatment in Adolescents
January 2012
Meera Beharry, MD
Division of Adolescent Medicine
University of Rochester Medical Center
ACT for Youth Center of Excellence
Cornell University Bronfenbrenner Center for Translational Research
Cornell University Cooperative Extension of New York City
New York State Center for School Safety
University of Rochester Medical Center Div. of Adolescent Medicine
Objectives
 Describe
current screening methods
 Understand reasons why repeat testing
would be necessary
 Discuss 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 TherapyHAART) 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 Tests
 First
licensed in 1997
 Only the Home Access HIV-1® test
system is approved by FDA
 Is actually home collection kit
 Must call in for results
 Expensive
http://www.cdc.gov/hiv/topics/testing/resources/qa/tests_work.htm#screening
Need to retest
Confirmatory Testing
 Mandatory
for positive results
 Western Blot
 Blood
draw
 Oral fluid
in 4 weeks if “indeterminate”
or negative
 Follow-up
Treatment




Highly Active AntiRetroviral 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
for symptoms or emergencies
 Using one’s primary care provider
appropriately
 Making, canceling, and rescheduling
appointments
 Coming to appointments on time
 Calling ahead of time for urgent visits
 Refilling of prescriptions on time
 Maintenance of one’s health insurance
 Negotiating multiple subspecialty providers
Jeffrey M Birnbaum, MD,MPH
SUNY 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
Summary
 Early
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 phone
 Via the DOH
website below
 National info by
texting your zip
code to KNOWIT
(566948) or
 www.HIVtest.org
NYS DOH HIV Counseling and Testing Resource Directory (11/10 Update)
www.health.ny.gov/publications/9515/index.htm
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
ACT for Youth Center of Excellence
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