This article is more than 5 years old. Information may no longer be current.

AAP recommends routine HIV screening in adolescents who live in areas with high disease rates

Committee on Pediatric AIDS. Pediatrics. 2011;doi:10.1542/peds.2011-1761.

Adolescents who live in areas with high HIV prevalence rates should be routinely screened by age 18 years, according to a new policy statement from the American Academy of Pediatrics.

The statement recommends specifically that routine screening be offered to all adolescents at least once by the time they are aged 16 to 18 years, when the prevalence of HIV in the patient population is more than 0.1%.

In areas of lower community HIV prevalence, “routine HIV testing is encouraged for all sexually active adolescents and those with other risk factors for HIV,” according to the statement.

The CDC recommends universal and routine HIV testing for all patients aged 13 to 64 years.

Other conclusions and recommendations offered by the AAP’s Committee on Pediatric AIDS include that high-risk youth should be tested annually for HIV, and adolescents tested for other sexually transmitted infections should be tested for HIV during the same visit. The authors of the statement also said EDs and urgent care facilities in high prevalence areas should implement routine HIV testing to “provide an excellent opportunity to reach youth who do not seek primary care services often.”

Physicians should be aware of symptoms of the acute retroviral syndrome (mononucleosis-like syndromes), and HIV RNA testing should be considered in the diagnostic workup when the appropriate risk factors are present.

As an essential part of routine adolescent care, pediatricians should assess sexual and substance use behaviors, and creating an environment of tolerance is also important, especially when facilitating discussions about gender and sexual orientation.

Preventive care screening, according to the AAP, should include universal coverage and adequate payment for HIV testing and related counseling. To maintain confidentiality, physicians should advocate for confidential billing practices related to HIV and STI testing in adolescent and young adults.

The authors of the AAP statement indicate that opt-out HIV testing is preferred if allowed by state laws; rapid HIV testing has similar sensitivity to enzyme-linked immunoassay and can provide immediate notification of preliminary results. However, physicians must follow the guidelines of their local jurisdictions for routine HIV opt-out testing in adolescents. The AAP encouraged pediatricians to “advocate for change when such jurisdictions create barriers for implementation of opt-out testing.”

Regarding HIV education and testing, the committee said pediatricians are encouraged to advocate for the dissemination of accurate, evidence-based prevention education, access to confidential HIV and STI testing and counseling, and HIV treatment. For adolescents with a negative HIV test result, pediatricians are advised to use that opportunity to counsel adolescents on sexual and drug-use behaviors to reduce future risk. Adolescents who have a positive HIV test result must be provided with age-appropriate HIV specialty care, including prenatal care when appropriate.

It is encouraging that the CDC is exerting a proactive stance regarding recommending HIV testing for adolescents, and the nationwide legalization of an opt-out mode of testing. Adolescents are at increased risk for sexually transmitted infections and HIV for many reasons. Many feel that they are invulnerable, and yet it is a frequent time of sexual exploration (65% report being sexually active), and most do not seek routine medical care. The availability of rapid, non-invasive, sensitive and specific diagnostic testing that is well accepted by youth increases its utility and should increase ease of implementation of the recommendations. Hopefully, pediatricians will heed the recommendations of the CDC to protect this young, vulnerable population. Standardized assessment tools and a confidentiality protocol can assist pediatricians in discussing sexual risk behaviors with adolescents in their practice, which should be performed, regardless of perceived risk.

Toni Darville, MD
Infectious Diseases in Children Editorial Board member

Disclosure: Dr. Darville reports no relevant financial disclosures.

Follow the PediatricSuperSite.com on Twitter.