Naswa Smriti, Marfatia Y S
Department of Skin VD, Government Medical College & SSG Hospital, Vadodara, India.
Indian J Sex Transm Dis AIDS. 2010 Jan;31(1):1-10. doi: 10.4103/0253-7184.68993.
Adolescence (10-19 years) is a phase of physical growth and development accompanied by sexual maturation, often leading to intimate relationships. Adolescent HIV/AIDS is a separate epidemic and needs to be handled and managed separately from adult HIV. The adolescents can be subdivided into student, slum and street youth; street adolescents being most vulnerable to HIV/AIDS. Among various risk factors and situations for adolescents contracting HIV virus are adolescent sex workers, child trafficking, child labor, migrant population, childhood sexual abuse, coercive sex with an older person and biologic (immature reproductive tract) as well as psychological vulnerability. The most common mode of transmission is heterosexual, yet increasing number of perinatally infected children are entering adolescence. This is due to "bimodal progression" (rapid and slow progressors) among the vertically infected children. Clinically, the HIV infected adolescents present as physically stunted individuals, with delayed puberty and adrenarche. Mental illness and substance abuse are important co-morbidities. The disclosure and declaration of HIV status to self and family is challenging and guilt in sexually infected adolescents and tendency to blame parents if vertically affected need special consideration and proper counseling. Serodiscordance of the twins and difference in disease progression of seroconcordant twins are added causes of emotional trauma. Treatment related issues revolve around the when and what of initiation of ART; the choice of antiretrovirals and their dosages; issues related to long term ADRs; sense of disinhibition following ART commencement; adherence and resistance.
青春期（10至19岁）是身体生长发育的阶段，伴随着性成熟，常导致亲密关系的出现。青少年艾滋病毒/艾滋病是一种独立的流行病，需要与成人艾滋病毒分开处理和管理。青少年可细分为学生、贫民窟青少年和街头青少年；街头青少年最易感染艾滋病毒/艾滋病。青少年感染艾滋病毒的各种风险因素和情况包括青少年性工作者、儿童贩运、童工、流动人口、儿童期性虐待、与年长者的强迫性行为以及生理（未成熟生殖道）和心理上的易感性。最常见的传播方式是异性传播，但越来越多的围产期感染儿童进入青春期。这是由于垂直感染儿童中的“双峰进展”（快速进展者和缓慢进展者）。临床上，感染艾滋病毒的青少年表现为身体发育迟缓，青春期和肾上腺初现延迟。精神疾病和药物滥用是重要的合并症。向自己和家人披露和声明艾滋病毒感染状况具有挑战性，性感染青少年的内疚感以及如果是垂直感染则倾向于责怪父母的情况需要特别考虑和适当的咨询。双胞胎的血清学不一致以及血清学一致的双胞胎在疾病进展上的差异是造成情感创伤的额外原因。与治疗相关的问题围绕着何时开始抗逆转录病毒治疗以及使用何种药物；抗逆转录病毒药物的选择及其剂量；与长期不良反应相关的问题；开始抗逆转录病毒治疗后的解禁感；依从性和耐药性。
