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

Abstract

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