HIV screening should be initiated at age 15 in adolescents, recommends AAP
USA: In a recently released updated guideline, the American Academy of Pediatrics (AAP) has recommended HIV screening in adolescents starting at age 15.
In its 2001 and 2011 policy statements, the AAP had encouraged HIV testing of all sexually active youth. The updated report, published in the journal Pediatrics, reflects changes in epidemiology, advances in diagnostic testing, and updated recommendations for HIV testing, post-exposure prophylaxis (PEP), and new guidance for preexposure prophylaxis (PrEP) in youth at risk for acquiring HIV infection.
Following are the report's key recommendations:
- Pediatricians are encouraged to create an environment of confidentiality and tolerance and facilitate open discussion of gender, sexual orientation and behavior, and sexual and reproductive health issues.
- Pediatricians should recognize the clinical presentation of the acute retroviral syndrome, which can present clinically as infectious mononucleosis-like and influenza-like syndromes, and consider adding virological testing to AG/AB testing in the diagnostic workup of sexually active youth when symptoms consistent with acute retroviral syndrome are present.
- Routine HIV screening is recommended for all youth 15 years or older, at least once, in health care settings.
- After initial screening, youth at increased risk, including sexually active youth, should be rescreened at least annually, potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; having sexual partners who are HIV-infected, of both genders, or injection drug users; exchanging sex for drugs or money; or those who have had a diagnosis of or request testing for other STIs).
- Youth who request HIV screening at any time should be tested, even in the absence of reported risk factors.
- For youth with a positive HIV test result in any health care or community setting, it is critical to facilitate and confirm prompt linkage to age-appropriate HIV specialty care.
- A negative HIV test result provides an opportunity to counsel youth on sexual and reproductive health issues and risk behaviors. All youth at risk for HIV acquisition should be offered HIV PrEP as part of a comprehensive prevention strategy that includes other prevention measures, including adherence to daily administration, and safer sex practices, including barrier protection, to reduce the risk of STIs
- Opt-out HIV testing is preferred if allowed by state laws; rapid AB and AB/AG HIV testing can provide notification of results within a short period of time. Pediatricians should follow the guidelines of their local jurisdictions for routine HIV opt-out testing in youth and are encouraged to advocate for change when such jurisdictions create barriers for implementation of opt-out HIV testing.
- In addition to the ambulatory outpatient clinics and inpatient wards, emergency departments and urgent care facilities in areas of high HIV prevalence should implement routine HIV screening for youth, which provides an excellent opportunity to reach youth who may not often seek primary care services.
- Use of HIV PEP with antiretroviral drugs should be considered for youth who may have been exposed to HIV after an episode of high-risk sexual activity or unsafe needle use or after sexual violence. Survivors of sexual violence should have baseline HIV testing as well as STI screening and treatment and should be offered mental health and other supportive counseling.
- Although parent or guardian involvement in adolescent health care is desired, in the majority of settings in the United States, consent of the adolescent should be sufficient to provide testing and treatment of HIV infection or STIs as part of sexual and reproductive health services. Pediatricians should make use of free and confidential community-based testing programs if there are cost or confidentiality concerns in the office practice setting.
- Pediatricians should be familiar with state laws regarding partner notification and should use reasonable means to persuade and support HIV-infected youth to encourage and/or refer partner(s) to be tested when applicable. Pediatricians seeing patients who are being tested for HIV infection or STIs should discuss health department anonymous partner notification services with youth.
- Pediatricians are encouraged to advocate for the dissemination of accurate, evidence-based prevention education including HIV PrEP, PEP, and access to confidential HIV and STI counseling, testing, and treatment and partner notification services for youth.
- Preventive care screening should include universal coverage and adequate payment for HIV testing, related counseling, PEP, and PrEP. Pediatricians can advocate for confidential billing practices related to HIV and STI testing and prevention in youth.
"Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis," was published in Pediatrics, the journal of the American Academy of Pediatrics (AAP).