HIV post-exposure prophylaxis in children and adolescents presenting for reported sexual assault

• Published in: Child abuse & neglect 2009-03, Vol.33 (3), p.173-178
• Main Authors: Girardet, Rebecca G, Lemme, Scott, Biason, Tiffany A, Bolton, Kelly, Lahoti, Sheela
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - statistics & numerical data; Acquired Immune Deficiency Syndrome; Acquired Immunodeficiency Syndrome (AIDS); Adolescent; Adolescents; Adult; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Assault; Biological and medical sciences; Child; Child Abuse; Child abuse & neglect; Child Abuse, Sexual; Child Sexual Abuse; Child, Preschool; Children; Children & youth; Drug Therapy; Enzyme-Linked Immunosorbent Assay; Female; Guideline Adherence - statistics & numerical data; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV post-exposure prophylaxis; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Incidence; Infant; Infectious diseases; Male; Medical sciences; Medications; Pediatrics; Practice Patterns, Physicians' - statistics & numerical data; Prescribing; Prevalence; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Risk; Risk Factors; Sex crimes; Sexual Abuse; Sexual Assault; Sexually transmitted diseases; Texas - epidemiology; Victimology; Victims of Crime; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2008.05.010

Abstract Background The appropriate use of antiretroviral medications to protect against infection with human immunodeficiency virus (HIV) is unclear in cases of sexual assault of children, for whom the perpetrator's risk of HIV is often unknown, and physical proof of sexual contact is usually absent. Objective In an effort to clarify prescribing practices for HIV post-exposure prophylaxis (PEP) at our institution, we examined records of all children tested for HIV for prevalence of infection, our experience with prescribing PEP, and follow-up rates. Design/methods Medical records at a sexual abuse clinic of all children tested for HIV during a 38-month period were reviewed for information concerning risk factors for HIV acquisition, STI test results, and PEP experience. Children were defined as PEP-eligible if they were within 96 hours of assault, and there was a report of sexual contact with the potential to transmit HIV. Results One thousand seven hundred and fifty children were tested for HIV during the study period. Five children had a positive HIV ELISA, but only one child was confirmed HIV-positive. Three hundred and three children were eligible to receive HIV-PEP, but it was only offered to 16 (5.3%), of whom 15 accepted the medications. None of the children prescribed PEP completed follow-up, but 11 children had limited follow-up. Conclusions Our results indicate that the prevalence of HIV infection among sexually abused children in our population is low, and follow-up rates are poor. Intensive efforts to try to ensure follow-up are warranted whenever PEP is prescribed. Further research may help better define the efficacy of PEP in sexually abused children and adolescents.