This is the current release of the guideline.

It updates a previously published version: Provisional Committee on Pediatric AIDS. Reducing the risk of human immunodeficiency virus infection associated with illicit drug use. Pediatrics 1994;94:945-7.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

• Human immunodeficiency virus (HIV)-1 infection
• Illicit drug use

Counseling
Prevention
Risk Assessment

Family Practice
Infectious Diseases
Internal Medicine
Pediatrics
Preventive Medicine

Advanced Practice Nurses
Health Care Providers
Physician Assistants
Physicians

To present strategies for reducing the risk of human immunodeficiency virus type 1 (HIV)-1 infection associated with illicit drug use

Children, adolescents, and young adults, particularly those who use illicit drugs

1. Assessing human immunodeficiency virus type 1 (HIV-1)-related risk behaviors
2. Counseling and educating patients and families by providing information about all known drugs including alcohol and tobacco and risky sexual behaviors
3. Promoting cessation or reduction of illicit drug use and entry into substance-abuse treatment programs
4. Decontamination of used injection drug equipment and access to sterile syringes and needles
5. Postexposure prophylaxis (PEP) with antiretroviral drugs

Risk of human immunodeficiency virus (HIV) acquisition and transmission

Searches of Electronic Databases

Not stated

Not stated

Expert Consensus (Committee)

Not applicable

Review
Review of Published Meta-Analyses

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

The transmission of human immunodeficiency virus type 1 (HIV-1) is one of many adverse consequences of illicit drug use. Initiatives to reduce the risk of HIV-1 transmission should include the following.

1. Engaging youth in care
   • Engagement of a youth in his or her own health care is critical to achieving a physician-patient relationship in which honest discussions about high-risk behavior are possible. Pediatricians should review their state laws governing health care services available to minors without parental consent. Confidentiality policies should be developed and discussed with both the youth and parent(s) present. Pediatricians should advocate for services (mobile vans, drop-in centers) that can engage hard-to-reach youth populations such as homeless and runaway youth.

2. Preventing and treating substance abuse
   • Primary prevention activities in the community and in care settings should be directed at families of preadolescents and youth and should promote healthy lifestyles. Physicians should support frank discussion between families and their children to avoid the initiation of illicit drug use, including alcohol and tobacco use. Parents also should be given information and strategies on ways to incorporate dialogue about substance use and sexual activity in their homes.
   • Pediatricians should advocate for youth-friendly substance-abuse treatment facilities that are able to accommodate all youth, including those who are uninsured, underinsured, and undocumented. Pediatricians should familiarize themselves with referral sources for substance-abuse prevention and treatment and mental health services.

3. Preventing acquisition of HIV-1 infection
   • Pediatricians should assess HIV-1-related risk behaviors as part of every health care encounter.
   • Pediatricians should advocate for seamless access to reproductive health care services for youth and be aware of the close association of illicit drug use and high-risk sexual activity.
   • Pediatricians should advocate for unencumbered access to sterile syringes and improved knowledge about decontamination of injection equipment. Physicians should be knowledgeable about their states' statutes regarding possession of syringes and needles and available mechanisms for procurement. These programs should be encouraged, expanded, and linked to drug treatment and other HIV-1 risk-reduction education. It is important that these programs be conducted within the context of continuing research to document effectiveness and clarify factors that seem linked to desired outcomes.
   • For youth with a single recent (within 72 hours) high-risk exposure to HIV-1 through either sharing needles/syringes with an HIV-1-infected individual or engaging in unprotected intercourse with an individual who engages in injection drug use, the risks and benefits of postexposure prophylaxis (PEP) with antiretroviral drugs should be considered. Such prophylaxis must be accompanied by risk-reduction counseling and referral to appropriate substance-abuse treatment.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Reduced human immunodeficiency virus (HIV)-1 infection achieved by preventing and treating illicit drug use, promoting healthy lifestyles, and using postexposure prophylaxis

Not stated

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Patient-centeredness
Timeliness

Not applicable: The guideline was not adapted from another source.

1994 (revised 2006 Feb)

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Pediatric AIDS

Committee on Pediatric AIDS, 2003-2004: Mark W. Kline, MD, Chairperson; Robert J. Boyle, MD; Donna Futterman, MD; Peter L. Havens, MD; *Lisa M. Henry-Reid, MD; Susan King, MD

Consultant: Lorry Rubin, MD

Staff: Jeanne Christensen Lindros, MPH

* Lead author

Not stated

This is the current release of the guideline.

It updates a previously published version: Provisional Committee on Pediatric AIDS. Reducing the risk of human immunodeficiency virus infection associated with illicit drug use. Pediatrics 1994;94:945-7.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

None available

This NGC summary was completed by ECRI on March 31, 2006. The information was verified by the guideline developer on April 11, 2006.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.