AAP recommends universal HIV screening starting at age 15 years

The AAP updated its guidance to recommend that all adolescents aged 15 years or older be screened for HIV at least once in a health care setting and that youth at an increased risk be screened at least once annually after that.

A 2011 policy statement from the AAP called for routine HIV screening for all adolescents at least once by age 16 to 18 years when the prevalence of HIV in the patient population was more than 0.1%.

The update reflected changes in epidemiology, advances in diagnostic testing and updated recommendations for HIV testing, postexposure prophylaxis (PEP) and new guidance regarding HIV PrEP, which the CDC now recommends be discussed with all sexually active patients, including adolescents.

The AAP published the updated guidance in a report in Pediatrics authored by Katherine K. Hsu, MD, MPH, FAAP and Natella Y. RakhmaninaMD, MPH, FAAP of the AAP’s Committee on Pediatric AIDS. In the report, the authors noted that in 2018, an estimated 45% of 13- to 24-year-olds living with HIV in the U.S. were undiagnosed — making them “disproportionately overrepresented compared with all other age groups unaware of their infection.”

“Of the 1.2 million people living with HIV and AIDS in the United States, approximately 14% are people whose infection had not been diagnosed, and it is this group that is estimated to account for 38% of HIV transmission; those aware of their HIV infection but not receiving HIV care account for an additional 43% of transmission,” they wrote.

The authors also said that youth with HIV infection are the “least likely of any age group to be linked to HIV care in a timely manner.”

“Youth also have lower rates of viral suppression, making them less likely to stay healthy and increasing their risk of HIV transmission to others,” the report said.

After an initial screening, the AAP recommends routine HIV screening for at-risk youth — including male youth reporting male sexual contact, injection drug users and transgender youth — at least once annually and potentially as often as every 3 to 6 months.

The AAP said laboratories should use FDA-approved fourth-generation antigen/antibody combination immunoassays to test for established and acute HIV infection. It encouraged clinicians to address adolescent sexual and reproductive health on a routine basis by “obtaining a sexual history, discussing healthy sexuality, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and performing appropriate screening and administering vaccinations.”

The authors also noted the importance of “creating safe environments that promote confidentiality and respect.” They noted that research has found that youth might forgo sexual and reproductive health services if parental consent is required.

In line with this, a study published in JAMA Pediatrics in November found that allowing teenagers to consent to the HPV vaccine in certain states resulted in higher immunization rates. Currently, 18 states allow physicians to inform a minor’s parent or guardian that he or she is seeking or receiving STI services, with only one state (Iowa) requiring parental notification about a positive HIV test result. The report recommended discussing a confidentiality policy with patients.

“Physicians have an ethical and legal obligation to maintain confidentiality regarding their patients’ confidential health information, the assurance of which is crucial in optimizing patient testing for HIV and personal disclosure,” the report read.

References:

AAP. American Academy of Pediatrics advises universal, routine HIV screening in teens and biomedical HIV prevention for youth at risk. https://www.aap.org/en/news-room/news-releases/aap/2021/american-academy-of-pediatrics-advises-universal-routine-hiv-screening-in-teens-and-biomedical-hiv-prevention-for-youth-at-risk/. Accessed Dec. 27, 2021.