adolescents creates challenge for clinicians HIV Clinician ISSN: 1551-885X See Adolescents, next page

did not appear. Regular issue numbering will resume with Vol. 19 in 2007. April Palmer, MD Since the fi rst diagnosis of AIDS was made in a series of gay white males 25 years ago, the demographics of the epi-demic have shifted. Although men who have sex with men (MSM) remain a high risk group, the worldwide epidem-ic now primarily involves people of color, including women and youth.1 In the US, the percentage of estimated new HIV cases (from the 33 states with name-based HIV reporting) in youth (ages 13-24 years) has increased from 10.4 % in 2001 to 12.6 % in 2004.2 These numbers may not refl ect the true infection rate in youth as several states do not report HIV infection without AIDS and many at risk youth are not tested. The Committee on Pediatric AIDS and Committee on Adoles-cence estimate that only 50 % of infected youth are diagnosed.3 A recent longitudinal study in adults 19-24 years of age (Add Health study), found the overall HIV prevalence in this group to be 1/1000.4 Since 1999 there has been a 37 % increase in the number of youth living with AIDS. Through 2003, 4 % percent of total AIDS cases and 2 % of AIDS deaths have occurred in youth. In 2003, only 17 % of youth aged 15-24 years progressed to AIDS within 12 months of HIV diagnosis.5 Therefore, a large population of undiagnosed HIV-infected youth is living in the US and at a stage in their disease where treatment is likely to prevent progression to AIDS. The challenge for outreach workers, case managers and cli-nicians is to locate HIV-infected youth, bring them into care, pre-vent attrition from medical care, and assure medication adherence for youth needing antiretroviral therapy. Many risk factors associated with HIV infection in adults are seen in youth. The main risk factor for all age groups is race/ethnicity with the highest prevalence rates occurrin