In recent years, the incidence of HIV infection has decreased for most age groups. Study results have shown that presenting to care earlier in the disease course can limit immune deterioration and HIV transmission. The CDC recommends that all people aged 13 and older be tested for HIV, a recommendation that appears to have made an impact on testing rates. However, recent research indicates that HIV incidence rates are actually increasing among adolescents.
Taking a Closer Look
“Studies have shown that more adults aged 18 and older are entering care with higher CD4 counts than what has been seen in the past,” says Allison L. Agwu, MD, ScM. “However, data from adult studies don’t necessarily represent trends in adolescents. My colleagues and I wanted to see if these same improvements in CD4 counts are also occurring in adolescents.”
For a retrospective cohort study published in JAMA Pediatrics, Dr. Agwu and colleagues assessed data on nearly 1,500 antiretroviral therapy-naïve patients aged 12 to 24 who presented for care between 2002 and 2010 at any of 13 clinics in the HIV Research Network. Throughout the study, the proportion of patients who presented for care with a CD4 count less than 350 cells/mm3 remained between 30% and 45%. “These patients are presenting having already met criteria for treatment,” Dr. Agwu says, “We’ve shown that these patients are actually less likely to be treated.”
African Americans, Hispanics, males, heterosexuals, older patients, and those with higher HIV-1 RNA levels were more likely than their counterparts to present for care with CD4 counts less than 350 cells/mm3. According to Dr. Agwu, providing extra support and attention to these subsets of patients is critical to getting them tested and linked to care.
Improving Patient Knowledge
The study findings serve as an argument for investing in the infrastructure and logistics required to link newly diagnosed patients to the HIV care they need, says Dr. Agwu. “When adolescents are diagnosed with HIV, they should be informed about the providers they need to see and the available resources in their area to link them to care,” she says. “Consistent follow-up and support are crucial to ensuring that these individuals are cared for appropriately.”
Dr. Agwu says that patient education should start with reducing the stigma around HIV and sex and helping patients understand that HIV is not a death sentence. “Patients need to be informed that knowing their HIV status is necessary to make sure they live a long, healthy life,” she says. “Talking about these issues and de-stigmatizing the disease will enhance our patient education efforts.”
Agwu A, Neptune A, Voss C, et al. CD4 counts of nonperinatally HIV-infected youth and young adults presenting for HIV care between 2002 and 2010. JAMA Pediatr. 2014 Feb 3 [Epub ahead of print]. Available at http://archpedi.jamanetwork.com/article.aspx?articleid=1827798&resultClick=3.
Althoff K, Gange S, Klein M, et al. Late presentation for human immunodeficiency virus care in the United States and Canada. Clin Infect Dis. 2010;50:1512-1520.
Rand C, Shone L, Albertin C, et al. National health care visit patterns of adolescents: implications for delivery of new adolescent vaccines. Arch Pediatr Adolesc Med. 2007;161:252-259.
O’Sullivan L, Udell W, Patel V. Young urban adults’ heterosexual risk encounters and perceived risk and safety: a structured diary study. J Sex Res. 2006;43:343-351.