HIV Screening, Testing and Treatment in Adolescents

1. January 2012 Meera Beharry, MD Division of Adolescent MedicineUniversity of Rochester Medical Center ACT for Youth Center of Excellence Cornell University Bronfenbrenner Center for Translational Research Cornell University Cooperative Extension of New York CityNew York State Center for School SafetyUniversity of Rochester Medical Center Div. of Adolescent Medicine HIV Screening, Testing and Treatment in Adolescents

2. Objectives • Describe current screening methods • Understand reasons why repeat testing would be necessary • Discuss treatment issues specific to adolescents

3. 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.

4. 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 Therapy-HAART) is able to stop the progression of HIV replication in the body, but requires compliance with therapy.

5. HIV Time Course Without Treatment

6. 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

7. HIV Screening Tests

8. Uni-Gold • FDA approved 2003 • Uses small amount of blood • For use by professionals only • Results in 10 minutes • Positive result must be confirmed

9. 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

10. 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

11. Need to retest

12. Confirmatory Testing • Mandatory for positive results • Western Blot • Blood draw • Oral fluid • Follow-up in 4 weeks if “indeterminate” or negative

13. Treatment • Highly Active Anti-Retroviral Therapy (HAART) • Early, consistent treatment can prolong life • Can prevent spread to unborn child • PEP: Post Exposure Prophylaxis

14. “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

15. 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

16. 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

17. 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

18. 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

19. 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

20. http://www.hivtest.org/

21. Resources • CDC: www.cdc.gov/hiv/ • NYS DOH AIDS Institute: http://www.nyhealth.gov/diseases/aids/ • 100 questions and answers about HIV/AIDShttp://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

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