Use of antiretroviral HIV post-exposure prophylaxis in sexually abused children and adolescents treated in an inner-city pediatric emergency department

In 2002, Georgia had the United States’ eighth highest number of persons living with AIDS. Human immunodeficiency virus (HIV) transmission as a result of sexual abuse is uncommon but definitely occurs. In certain circumstances of sexual abuse, antiretroviral post-exposure prophylaxis (ARV-PEP) has been suggested as a means to decrease the risk of HIV infection. Our objective was to assess the utilization of ARV-PEP in patients being evaluated for sexual abuse at a pediatric emergency department in a city with high HIV prevalence. A retrospective survey of the characteristics of sexual abuse victims was conducted using information abstracted from sexual abuse report forms of minors examined in 2002 at an inner-city Atlanta children's hospital. Of 227 victims, aged 9 months to 18 years, most were Black, inner-city residents; 190 (84%) patients were female. Only 87 of 227 (38.3%) were seen within 72 h of the abuse, the time frame for offering ARV-PEP. Twenty-three of the 87 had anogenital trauma or bleeding. Five (5.7%), were provided ARV-PEP, whereas 60 (69%) received antibiotic prophylaxis for non-HIV diseases. Those assaulted by strangers were greater than 10 times more likely to be provided ARV-PEP than others ( p = .02). Assailants of the 82 victims who did not receive ARV-PEP included 22 strangers and 60 “acquaintances” of unknown serostatus. For a high HIV prevalence area, the proportion of sexual abuse victims prescribed ARV-PEP was small in relation to those at risk of HIV sexual exposure. Clinicians should be provided guidance on interpretation of community HIV and sexual abuse victim data to assess the appropriateness of ARV-PEP. En 2002, la Géorgie était au huitième rang des états pour le nombre de personnes vivant avec le SIDA aux Etats-Unis. La transmission du virus d’immuno-déficience humaine (VIH) comme conséquence d’une agression sexuelle n’est pas fréquente mais peut arriver. Dans certaines circonstances, une prophylaxie antirétrovirale post-exposition (PARV-PE) a été proposée comme un moyen de diminuer le risque d’infection VIH. Notre but a été d’évaluer l’utilisation de la PARV-PE chez des patients examinés pour agression sexuelle dans un service d’urgence pédiatrique d’une ville avec haute prévalence de VIH. Une étude rétrospective des caractéristiques des victimes d’agression sexuelle a été réalisée en utilisant les renseignements provenant des constats d’agression sexuelle sur des mineurs examinés en 2002 dans un hôpital du centre-ville