Antiretroviral Guidelines

US DHHS Guidelines with Australian commentary

Adolescents and Young Adults with HIV

Last Updated: December 18, 2019; Last Reviewed: December 18, 2019

Key Summary and Panel’s Recommendations Regarding Adolescents and Young Adults with HIV

AU comment: Adolescents and young adults in Australia

Key Summary and Panel’s Recommendations

Key Considerations and Recommendations
  • Adolescents living with HIV largely belong to two distinct groups—those who acquired HIV in infancy and are heavily antiretroviral therapy (ART)-experienced, and those who acquired HIV more recently during their teens.
  • ART is recommended for all individuals with HIV (AI) to reduce morbidity and mortality and to prevent HIV transmission. Therefore, ART is also recommended for ART-naive adolescents.
  • Before initiation of therapy, adolescents’ readiness and ability to adhere to therapy within their psychosocial context need to be carefully considered as part of therapeutic decision making (AIII).
  • Once ART is initiated, appropriate support is essential to reduce potential barriers to adherence and maximize the likelihood of achieving sustained viral suppression (AII).
  • Data from an observational study in Botswana suggest that there may be an increased risk of neural tube defects in infants born to individuals who were receiving dolutegravir at the time of conception. Before initiating an integrase strand transfer inhibitor-based regimen in an adolescent of childbearing potential, clinicians should review Table 6b for information to consider when choosing an ART regimen.
  • The adolescent sexual maturity rating (SMR) can help guide regimen selection when initiating or changing an ART regimen as recommended by either the Adult and Adolescent Antiretroviral Guidelines or the Pediatric Antiretroviral Guidelines. The Adult and Adolescent Aniretroviral Guidelines are more appropriate for postpubertal adolescents (i.e., those with SMRs of 4 or 5) (AIII).
  • Pediatric and adolescent care providers should prepare adolescents for the transition into adult care settings. Adult providers should be sensitive to the challenges associated with such transitions, consulting and collaborating with adolescent HIV care providers to ensure adolescents’ successful transition and continued engagement in care (AIII).
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert Opinion