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Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors

Koenig, Linda J.a; Nesheim, Stevena; Abramowitz, Susanb

Current Opinion in Obstetrics and Gynecology: October 2011 - Volume 23 - Issue 5 - p 321–327
doi: 10.1097/GCO.0b013e32834a581b
Adolescent and pediatric gynecology: Edited by Paula J. Adams Hillard

Purpose of review Because of widespread availability of highly active antiretroviral therapy in the developed world, a large proportion of children with perinatally acquired HIV have survived to adolescence and young adulthood. Although their survival is remarkable, many now experience the long-term effects of HIV infection and its treatment. Further, as these youths have entered adolescence, more is known about the impact of normative developmental transitions on health maintenance behaviors.

Recent findings Although perinatally infected adolescents are healthier than they were a decade or more ago, they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. Three behavioral health challenges have been documented in the first cohort of long-term survivors: decreased medication adherence, sexual debut and accompanying pregnancy and transmission risk, and mental health problems. These issues are consistent with a developmental press for autonomy, mature sexual relationships and future planning, but must be carefully managed to preserve health.

Summary Adolescents with perinatally acquired HIV require coordinated multidisciplinary support services – including adherence support, reproductive health counseling addressing both pregnancy planning and disease transmission, and mental health and educational/vocational planning – so that they can fully benefit from treatment advances.

aCenters for Disease Control and Prevention, Atlanta, Georgia, USA

bNew York University School of Medicine, New York, New York, USA

Correspondence to Linda J. Koenig, PhD, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop D-27, Atlanta, GA 30333, USA Tel: +1 404 639 5192; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.