Psychiatric Illness and the HIV Teen
Ann Usitalo, PhD

In HIV-infected adults, psychiatric disorders result in poor quality of life, HIV disease progression, poor compliance, and increased mortality. The same may be true for children and adolescents challenged with HIV/AIDS. Much less is known about the spectrum of psychiatric illness in pediatrics as compared to adults. This session will discuss the spectrum of psychiatric illness in HIV-infected children and adolescents as well as review different strategies for management.
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HIV and Bone Mineral Density-Vitamin D Deficiency
George Siberry, MD, MPH

Low bone mineral density is prevalent in HIV infected subjects. Recent studies have also described increased fracture rates in this population. Like adult patients, HIV-infected youth are also at increased risk of low bone mineral density due to HIV infection, its treatment, co-morbid conditions, and other factors. Progressive bone mineral loss at an age when bones are usually at the peak of growth and mineral deposition may put young patients at increased risk of fractures in the short and long term. This session will discuss available data on what is known about loss of progressive bone mineral density in children and adolescent patients with HIV infections. Risk factors, short- and long-term complications, and management strategies will be outlined.
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Adolescent HIV and Pregnancy- Advanced Management and Cases
Amanda Cotter, MD

Pregnancy is a significant event for the adolescent female, especially those with vertically or horizontally acquired HIV infection. This presentation will address the important issues in the management of the HIV-positive adolescent pregnancy including; the similarities and differences for vertically-infected or horizontally-infected adolescents, the current guidelines for preventing perinatal HIV transmission, and a discussion of the pros and cons of vaginal versus cesarean section deliveries in adolescents.  Case-based discussions will highlight and elucidate important issues in the management of the HIV-positive pregnant adolescent.
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Palliative Care for Adolescents: Cases and Panel Discussion
Ana Garcia, PhD, LCSW, Belinda Beauchamp, MD, and Ann Usitalo, PhD

The subject of palliative care has always been a challenging one for pediatricians. As HIV-infected children age, particularly those who were infected perinatally, many refuse to take medications citing simple fatigue in complying with challenging medication regimens as well as reported side effects of medications as the most common reasons for non-compliance. Pediatric and adolescent providers are being faced with the challenge of making difficult decisions with young patients and their caregivers regarding end of life decisions. This panel will attempt to discuss these daunting issues in the HIV infected non-compliant adolescent population.
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Metabolic Complications-Dyslipidemia
George Siberry, MD, MPH

Long-term HIV infection in growing children and chronic HAART can lead to significant perturbations in normal metabolic function.  This presentation will consider the basic proposed mechanisms relative to HIV infection and antiretroviral therapy and their effect on lipid metabolism. This presentation will also consider the contribution of dyslipidemia to the development of metabolic syndrome in HIV-infected adolescents, what is known about dyslipidemia and HIV infection, cardiovascular disease risk, appropriate evaluation, and therapeutic interventions for dyslipidemia in the HIV infected adolescent.
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Initiating HAART in the Newly Infected Adolescent
Jorge Lujan-Zilbermann, MD, MS

Newly HIV infected adolescents represent a unique population in whom to try to initiate ARV therapy. This presentation will review the current guidelines (US DHHS and IAS-USA) for initiating ARV therapy and their applicability to adolescents. The timing of initiation of therapy relative to adolescent readiness and likelihood of compliance/success will be discussed. The selection of an individualized ARV regimen based on “baseline line genotype”, co-morbid conditions, drug interactions, potential side effects, and lifestyle and behavioral issues will be presented. Several potential initial regimens will be considered in case-based examples.
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Pharmacokinetic Variability and Drug Interactions
Michael Thompson, PharmD, BCNSP

Differences in drug disposition and response between pediatric and adult patient populations are substantial. Pharmacokinetic variability due to the differing body compositions of pediatric and adult patients, changes in drug distribution and elimination related to maturation, as well as endocrinologic effects associated with the changes at puberty all make pediatric and adolescent patients significantly different from adults in terms of dosing medications. Limited data in the pediatric and adolescent population make administration of HAART medications particularly challenging. This session will focus on some of the pharmacokinetic (PK) and pharmacodynamic (PD) differences and major drug interactions seen in HIV-infected children and adolescents.
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HIV and Renal Disease in Adolescents
Gwendolyn B. Scott, MD

With the advent of antiretroviral therapy, there has been a dramatic reduction in the survival of HIV-infected patients; however, this has resulted in increasing prevalence of renal disease even among young people. The incidence of renal complications has increased in part due to the primary infection and in part due to the nephrotoxic effects of HAART medications. HIV associated nephropathy (HIVAN) is the most common and aggressive of the renal diseases that can occur with HIV infection progressing to end stage renal disease within months. This session will discuss the different renal diseases seen with HIV infection in children and adolescents as well as identify renal risk factors before initiation of and during antiretroviral therapy, including the interplay between underlying renal disease and nephrotoxicity associated with medications.
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Prevention Intervention with Teens: Panel Discussion
Carol M. Fulton, MSN, ARNP, CPNP and Lawrence B. Friedman, MD

HIV prevention intervention is always a challenge with adolescents.  This will be a panel presentation and discussion of previously tested effective interventions, along with a demonstration of available resources. The use of peer counselors and specifically HIV-positive youths to communicate the message to other youths will be demonstrated.
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Pediatric Cases - Conundrums
Robert M. Lawrence, MD and Ayesha Mirza, MD, FAAP

This will be a case-based discussion of specific clinical scenarios with comparison and contrasting of different opinions and options for management.  The discussion will focus on available data applicable to the clinical scenario, an analysis of the clinical situation and the data, recommendations for management, and a discussion of the PROs and CONs of the recommendations.  The cases to be considered will include; a) confusing HIV lab results in 1-2 year infants exposed to HIV, b) addressing non-compliance in an HIV-positive adolescent, c) Choosing a “salvage” ARV regimen for a teenager, d) autoimmune disease and HIV together, e) primary HIV infection in a teenager.
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