Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Pediatr. 2020 Nov 1;174(11):1102-1108. doi: 10.1001/jamapediatrics.2020.0824.
Many adolescents and young adults in the US are disproportionately affected by HIV. Several others who are uninfected are at risk and in need of effective preventive strategies. The uptake rate of preexposure prophylaxis (PrEP) for HIV prevention has remained low among US adolescents. This review assesses the current status of PrEP uptake among at-risk adolescents aged 13 to 19 years and recommendations for improving PrEP access, uptake, and future needed directions, including specific recommendations for health care professionals.
Of the 37 377 new HIV diagnoses made in 2018, 7734 diagnoses (21%) occurred in adolescents and young adults aged 12 to 24 years; of these, 1707 diagnoses (22%) occurred in adolescents aged 13 to 19 years. The greatest burden of HIV is found among young African American men who have sex with men, accounting for two-thirds of all HIV infections in adolescents and young adults. Preexposure prophylaxis awareness and engagement are lowest in adolescents with the greatest risk for HIV. Adolescent primary care clinicians and specialists do not routinely offer HIV testing as recommended by the Centers for Disease Control and Prevention or routinely assess sexual risk exposures of patients through sexual history taking. Clinicians' decision to prescribe PrEP for adolescents is often guided by their perceptions of the patient's HIV risk and their knowledge and acceptance of PrEP guidelines. State laws on consent, confidentiality, and the rights of the adolescent to independently access PrEP outside of parental influence differ across jurisdictions, often limiting access and uptake.
Use of PrEP in adolescents at risk for HIV is an important component of HIV prevention. Optimizing uptake includes improving clinicians' knowledge about HIV risk and prevention strategies, enhancing sexual history taking and risk assessment through training and retraining, and improving PrEP knowledge and acceptance of prescribing among clinicians. Leveraging the ubiquity of social media, encouraging family support, and performing research aimed at finding lifestyle-congruent formulations can help mitigate HIV transmission in adolescents at greatest risk for HIV.
美国有许多青少年和年轻人受到 HIV 的不成比例影响。还有一些未感染的人处于危险之中，需要有效的预防策略。 用于 HIV 预防的暴露前预防 (PrEP) 的采用率在美国青少年中仍然很低。 本综述评估了高危青少年 (13 至 19 岁) 中 PrEP 采用的现状，以及改善 PrEP 可及性、采用率和未来所需方向的建议，包括为卫生保健专业人员提供的具体建议。
在 2018 年诊断的 37377 例新 HIV 诊断中，有 7734 例 (21%) 发生在 12 至 24 岁的青少年和年轻人中；其中，1707 例 (22%) 发生在 13 至 19 岁的青少年中。HIV 的最大负担发生在与男性发生性关系的年轻非裔美国男性中，占青少年和年轻人所有 HIV 感染的三分之二。 对 HIV 风险最大的青少年中，PrEP 意识和参与度最低。 青少年初级保健临床医生和专家并未按照疾病控制与预防中心的建议常规提供 HIV 检测，也未通过性史询问常规评估患者的性风险暴露情况。 临床医生为青少年开 PrEP 的决定通常取决于他们对患者 HIV 风险的看法以及他们对 PrEP 指南的了解和接受程度。 关于同意、保密以及青少年在父母影响之外独立获得 PrEP 的权利的州法律因司法管辖区而异，这常常限制了 PrEP 的可及性和采用率。
在有 HIV 风险的青少年中使用 PrEP 是 HIV 预防的重要组成部分。 优化采用率包括提高临床医生对 HIV 风险和预防策略的了解，通过培训和再培训增强性史询问和风险评估，提高临床医生对 PrEP 的了解和接受程度。 利用社交媒体的普及性，鼓励家庭支持，并进行旨在寻找与生活方式一致的配方的研究，有助于减少高危青少年中的 HIV 传播。
