Antiretroviral Guidelines

US DHHS Guidelines with Australian commentary

Adolescents and Young Adults with HIV

Last Updated: October 25, 2018; Last Reviewed: October 25, 2018

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

  • 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. Thus, 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).
  • Preliminary data from Botswana suggested that infants born to women who were receiving dolutegravir (DTG) at the time of conception have an increased risk of neural tube defects. Until more information is available, DTG should not be prescribed for adolescents:
    • Who are pregnant and within 12 weeks post-conception;
    • Who are of childbearing potential, are sexually active, and who are not using effective contraception; or
    • Who are contemplating pregnancy.
  • The adolescent sexual maturity rating (SMR) can be helpful to guide regimen selection for initiation of or changes in ART as recommended by either these Adult and Adolescent Antiretroviral Guidelines or the Pediatric Guidelines. These Adult and Adolescent 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