Considerations for Antiretroviral Therapy in the HIV-Infected Adolescent

HIV-infected adolescents who were infected sexually or via injection drug use during adolescence appear to follow a clinical course that is more similar to HIV disease in adults than in children. In contrast, adolescents who were infected perinatally or via blood products as young children have a unique clinical course that may differ from other adolescents and long-term surviving adults. Currently, most HIV-infected adolescents were infected sexually during the adolescent period and are in a relatively early stage of infection.

Puberty is a time of somatic growth and hormonally-mediated changes, with females developing more body fat and males more muscle mass. Although theoretically these physiologic changes could affect drug pharmacology, particularly in the case of drugs with a narrow therapeutic index that are used in combination with protein-bound medicines or hepatic enzyme inducers or inhibitors, no clinically significant impact of puberty has been noted to date with the use of NRTIs. Clinical experience with PIs and NNRTIs has been limited. Thus, it is currently recommended that medications used to treat HIV and opportunistic infections in adolescents should be dosed based on Tanner staging of puberty and not specific age. Adolescents in early puberty (Tanner I-II) should be dosed under pediatric guidelines, while those in late puberty (Tanner V) should be dosed by adult guidelines. Youth who are in the midst of their growth spurt (Tanner III females and Tanner IV males) should be closely monitored for medication efficacy and toxicity when choosing adult or pediatric dosing guidelines.

previous page | next page

return to table of contents