On February 23, 2018, the CDC published a new analysis that provided a clearer picture of the remarkable escalations in HIV diagnosis rates among adolescents as age increases between 13 and 21 years.
Between 2010 and 2014, in 50 states and the District of Columbia, 78,337 persons aged between 13 and 29 years had diagnosed HIV infection. The overall HIV diagnosis rate was 21.3 per 100,000 population. In 2014, persons aged 13 to 29 years represented 23 percent of the U.S. population, yet accounted for 40 percent of diagnoses of human immunodeficiency virus (HIV) infection in the U.S. during the same year.
HIV diagnoses analyzed by age groups revealed striking differences in rates of diagnosis of HIV infection between ages 13 and 21 years. Between 2010 and 2014, HIV infection diagnosis rates per 100,000 population varied substantially with increasing age among persons aged 13 to 15 years (0.7), 16 to 17 years (4.5), 18 to 19 years (16.5), and 20 to 21 years (28.6). HIV diagnosis rates were higher, but less variable, among persons aged 22 to 23 years (34.0), 24 to 25 years (33.8), 26 to 27 years (31.3), and 28 to 29 years (28.7).
Between 2010 and 2014, the overall HIV diagnosis rate among persons aged between 13 and 29 years remained stable (estimated annual percent change = 0.4, 95% CI = −0.1 to 0.9). However, these broad age groups encompass multiple developmental stages and potentially mask trends associated with the rapid psychosocial changes during adolescence through young adulthood. To better understand HIV infection among adolescents aged 13 to 17 years and young adults aged 18 to 29 years in the United States and identify ideal ages to target primary HIV prevention efforts, the CDC analyzed data from the National HIV Surveillance System (NHSS) using narrower age groups. By these narrower age groups, rates per 100,000 population increased between 2010 and 2014 among persons aged 24 to 25 years (from 32.4 to 35.4) and 26 to 27 years (from 30.2 to 33.9) and decreased among persons aged 16 to 17 years (from 5.0 to 4.2), 18 to 19 years (from 17.7 to 15.6), and 20 to 21 years (from 30.1 to 28.3). Rates remained stable among persons aged 13 to 15, 22 to 23, and 28 to 29 years. In light of the remarkable increase in rates between ages 16 to 17, 18 to 19, and 20 to 21 years, and a recent study revealing that infection precedes diagnosis for young persons by an average of 2.7 years, these findings demonstrate the importance of targeting primary prevention efforts to persons aged under 18 years old and continuing through the period of elevated risk in their mid-twenties.
Among persons aged 13 to 29 years with infection diagnosed between 2010 and 2014, blacks/African Americans accounted for the highest number and rate of HIV diagnoses (40,755 [52.0%]; 390.6 per 100,000 population), followed by Hispanics/Latinos (17,386 [22.2%]; 113.1). Among 66,471 males with diagnosed HIV infection, 59,634 (89.7%) had infections attributable to male-to-male sexual contact, and among these, males aged 22 to 23 years accounted for the highest number of diagnoses (12,275 [20.6%]). Among 11,866 females with diagnosed HIV infection, 10,462 (88.2%) had infections attributable to heterosexual contact, and among these, females aged 26 to 27 and 28 to 29 years accounted for the highest numbers of diagnoses (1,891 [18.1%] and 1,904 [18.2%], respectively). By region, the South accounted for the highest number and rate of HIV diagnoses among persons aged 13 to 29 years (40,667 [51.9%]; 148.2 per 100,000 population).
Adolescence and young adulthood are periods of considerable biologic and physiologic change and represent developmental phases when engagement in high-risk sexual behaviors and alcohol and other drug use peak and the risk for acquiring HIV infection increases. However, few HIV-related studies have taken into account these developmental transitions, and studies rarely include persons under the age of 18. A recent longitudinal study in an urban area with high HIV prevalence among men aged 16 to 20 years who have sex with men found that HIV incidence was just as high among participants under the age of 18 as among older participants, highlighting the importance of including adolescents under the age of 18 in research and prevention efforts, particularly HIV testing. A previous study has also shown delays in diagnosis of HIV infection of an average of 2.7 years in persons aged 13 to 24 years, indicating that the period of risk for HIV acquisition begins before age 18 years.
See the CDC Report