The long term objective of this proposal is to develop thought a cooperative agreement an adolescent Medicine Trial Network (ATN) that will enroll and retain adolescents ages 12 to 24 years in intervention research related to primary, secondary, and tertiary HIV/AIDS prevention studies. A research agenda will be developed by the Adolescent Medicine Leadership Group (AMLG) using behavioral, microbicidal, prophylactic, therapeutic and vaccine trails both independently and collaboration with existing networks. The majority of these studies will focus on collaboration with such networks as the HIV prevention Trails Network, HIV Vaccine Network, Pediatric and Adult AIDS Clinical Trails Groups, and the Community Programs for Clinical Research on AIDS to implement the ATN research agenda. The current application is to develop an Adolescent Medicine Treatment Unit (AMTU) that will enroll at least 75 HIV-infected and 125 HIV-uninfected youth ages 12 to 24 years into clinical trails as designated by the AMLG. The overarching goal of this proposal is to develop innovate strategies that combine behavior management and therapeutics to impact HIV disease in sexually active adolescents at multiple stages of health and care, particularly minority youth hardest hit by the HIV epidemic. Additionally, the growing population of patients perinatal transmitted HIV infection who have aged into the adolescent and young adult population require multifaceted evaluations of their behavior and biology. Regardless of their age at diagnosis, these youth with perinatal HIV infection face many of the same myriad psychosocial and developmental challenges as their sexually-infected peers but from the perspective of a long term chronic disease. As many of the perinatal infected youth become sexually active adolescents, they struggle with developmental issues that effect their medication and other health risks. The Modlin Report of the Office of AIDS Research describes the need to explore an effort at primary prevention that combines multiple strategies simultaneously focused on the goal of HIV prevention. For example, innovative behavior change combine with prophylactic microbicide and barriers in high risk HIV negative population would address the problem of HIV transmission from several approaches. With rear to therapeutic opportunity, adolescence may provide a potential for immune reconstruction unavailable in children or adults that may inform both traditional antiretroviral therapy approach as well as less traditional immune enhancement therapeutics. The etiology and implications of poor adherence, for which adolescents have great notoriety, is inadequately understood in HIV infection and requires new intervention strategies. Co- morbidities of sexually transmitted infections have been documented but the long term consequences of these infections requires further study. Finally, the communication to community organizations of prevention strategies that are successful and of strategies that fail is an essential component of that required work.
