Clinical manifestations of infection with human immunodeficiency virus among adolescents in Louisiana

Abstract

There is limited information regarding the clinical manifestations of human immunodeficiency virus (HIV) infection among adolescents. To better define the clinical presentation and course of HIV disease in this population, a retrospective review of all HIV-infected persons age 13-21 years at entry into a public, inner-city HIV outpatient clinic in New Orleans, Louisiana, was undertaken. A total of 141 adolescents were included in this study. The cohort was predominantly female (65%) and African-American (83%), and acquired HIV infection through sexual contact (89%). As many as 75% of the females and 48% of the males were diagnosed with at least one sexually transmitted disease (STD), respectively, and young African-American females with a CD4 cell count > 500/mm3 were at highest risk. The proportions of female adolescents having a gravida > or = 1 and 2 were 82% and 20%, respectively. A total of 55% of females were diagnosed with squamous intraepithelial lesions (SIL) at least once. Similar to adults, the majority of opportunistic processes occurred in adolescents with a CD4 cell count < 200/mm3. Known HIV-related symptoms (oral hairy leukoplakia, thrush, and zoster) were significantly predictive (p < .0001) for HIV disease progression. Although HIV-related symptoms and infections do not appear to be unique in the adolescent population, it is clear that STDs and pregnancies are common among female adolescents. Our results emphasize the need for aggressive STD and contraceptive protection counseling, and surveillance screening for STDs and cervical dysplasia.