Postexposure Prophylaxis for HIV in Children and Adolescents After Sexual Assault: A Prospective Observational Study in an Urban Medical Center

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Abstract

Background:

We sought to evaluate the tolerability and feasibility of establishing an HIV postexposure prophylaxis (PEP) program at our hospital using the guidelines for children and adolescents after sexual assault.

Methods:

This study was a prospective, nonrandomized observational study conducted from March 1999 until September 2002. Subjects (age <19 years) who presented to a pediatric emergency room within 72 hours of a sexual assault were eligible for enrollment. A 28-day PEP regimen of zidovudine and lamivudine was given.

Results:

In all, 70 adolescents were evaluated and 33 (31 females and 2 males) were enrolled. The mean age of enrolled subjects was 15 years, 61% were Hispanic, 30% black, and 79% presented to the emergency room within 24 hours of assault. Vaginal exposure was the most common site of penetration (64% [21 of 33]), but 18% (6 of 33) reported anal penetration. Only 9 subjects (27%) took ≥90% of all the medications. All subjects who returned for follow up tested HIV-negative. Adverse events occurred in 48% (16 of 33) of subjects; the most common events were abdominal pain, nausea, or vomiting.

Conclusion:

Poor adherence to medications and visits is a significant problem in PEP programs for sexually assaulted children and adolescents.

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