Prevention of HIV Infection in Adolescents

One half of all new cases of human immunodeficiency virus (HIV) infections in the United States occur among persons 13 to 24 years of age, according to the American Academy of Pediatrics (AAP). Most of these cases are sexually transmitted. Physicians may be able to help slow the spread of infection by educating young patients about HIV prevention, transmission and testing. The Committee on Pediatric AIDS and the Committee on Adolescence of the AAP have issued a statement on the role of the physician in the prevention of HIV infection in adolescents. The AAP statement appears in the January 2001 issue of Pediatrics.

Regarding the issue of HIV infection in adolescence, the AAP committees have issued the following conclusions and recommendations:

• Physicians should provide information about HIV infection and acquired immunodeficiency syndrome, and make HIV testing available to all adolescent patients.

• Prevention guidance should include helping adolescents understand the responsibilities of becoming sexually active, including counseling about the correct and consistent use of latex condoms.

• Availability of HIV testing should be discussed with all adolescents and should be encouraged for those who are sexually active or are substance users.

• Consent of an adolescent alone should be sufficient to provide evaluation and treatment for suspected or confirmed HIV infection.

• A negative HIV test result can alleviate anxiety resulting from a high-risk event or high-risk behaviors and is a good opportunity to counsel the patient on reducing future risk.

• When adolescents have a positive HIV test result, the physician should provide support, address medical and psychosocial needs, and arrange for appropriate care.

• Physicians must help adolescents with HIV infection understand the importance of informing sexual partners of their potential exposure to HIV. This assistance can be provided directly or by referral to a state or local health department.

ACSM Statement on the Physiology of Aging

The American College of Sports Medicine (ACSM) has released an official statement on the physiology of aging, including what can be done to slow or stop the loss of muscle mass and the impairment of muscle function with age. The statement appears in the ACSM's Current Comments, February 2001.

According to the ACSM, the most often reported consequence of normal aging is the loss of skeletal muscle mass, which may be related to changes in both muscle fiber area and fiber number. While studies show that Type I muscle fibers are resistant to age-associated atrophy, at least until 60 to 70 years of age, the relative area of Type II muscle fibers appears to decline with increased age. The loss of muscle fibers affects men and women, and is most noticeable around 50 years of age.

The ACSM reports that recent studies show elderly skeletal muscle is able to adapt to short-term (12 weeks) training programs by increasing strength through muscle hypertrophy of both types of fibers and improved functional performance.

Current research indicates that elderly muscle can adapt positively to resistance exercise. Significant improvements in strength caused by muscle hypertrophy may result from increased sensitivity of androgen receptors and increased levels of circulating factors responsible for muscle growth, such as testosterone and growth hormone.

The ACSM has published position stands on exercise for healthy adults as well as for older adults. They state that age should not be a deterrent for beginning an exercise program (although medical approval should be obtained), and that the exercises should be progressive in nature, individualized and involve all the major muscle groups. Exercising should be done two to three times per week with at least one set of eight to 15 repetitions. Multiple sets may be more beneficial and exercises that help with balance and posture are recommended.

Current Comments are official statements by the ACSM concerning topics of interest to the public at large. More information may be obtained by calling 317-637-9200 or by writing to the ACSM, P.O. Box 1440, Indianapolis, IN 46206-1440.