Robert D Schremmer1, Douglas Swanson, Kathe Kraly. 1. Division of Emergency Medical Services, Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. rschremmer@cmh.edu
Abstract
OBJECTIVES: This study was performed at an urban children's hospital to identify the characteristics of patients given human immunodeficiency virus (HIV) postexposure prophylaxis and describe the adherence and associated side effects of HIV prophylaxis in child and adolescent victims of sexual abuse. METHODS: A retrospective review of all children presenting for evaluation of suspected sexual abuse who were provided HIV prophylaxis between February 1999 and March 2001 was performed. Measured variables included risk factors for transmission of HIV, antiretrovirals prescribed and their side effects, initial and follow-up laboratory results, and compliance. RESULTS: The medical records of 34 patients were examined. Assault by a stranger was the most common risk factor prompting prophylaxis. Zidovudine and lamivudine were prescribed for 32 patients (94%). Only 17 patients (50%) kept at least 1 follow-up appointment; 8 patients (24%) finished the entire course of prophylaxis. Side effects were reported in 11 (65%) of 17 patients, but only 1 patient was known to have stopped prophylaxis because of subjective side effects, and 1 patient was removed from prophylaxis due to laboratory abnormality. CONCLUSIONS: Adherence to medication regimen and follow-up appointments in victims of suspected sexual abuse who are provided HIV prophylaxis is poor. The medications are associated with several side effects, but rarely do the side effects prohibit their use. Given difficulties with compliance, potential adverse effects of medications, and the high cost of treatment, care should be taken in offering prophylaxis to only those at increased risk for transmission of disease.
OBJECTIVES: This study was performed at an urban children's hospital to identify the characteristics of patients given human immunodeficiency virus (HIV) postexposure prophylaxis and describe the adherence and associated side effects of HIV prophylaxis in child and adolescent victims of sexual abuse. METHODS: A retrospective review of all children presenting for evaluation of suspected sexual abuse who were provided HIV prophylaxis between February 1999 and March 2001 was performed. Measured variables included risk factors for transmission of HIV, antiretrovirals prescribed and their side effects, initial and follow-up laboratory results, and compliance. RESULTS: The medical records of 34 patients were examined. Assault by a stranger was the most common risk factor prompting prophylaxis. Zidovudine and lamivudine were prescribed for 32 patients (94%). Only 17 patients (50%) kept at least 1 follow-up appointment; 8 patients (24%) finished the entire course of prophylaxis. Side effects were reported in 11 (65%) of 17 patients, but only 1 patient was known to have stopped prophylaxis because of subjective side effects, and 1 patient was removed from prophylaxis due to laboratory abnormality. CONCLUSIONS: Adherence to medication regimen and follow-up appointments in victims of suspected sexual abuse who are provided HIV prophylaxis is poor. The medications are associated with several side effects, but rarely do the side effects prohibit their use. Given difficulties with compliance, potential adverse effects of medications, and the high cost of treatment, care should be taken in offering prophylaxis to only those at increased risk for transmission of disease.
Authors: Roland C Merchant; Kenneth H Mayer; Bruce M Becker; Allison K Delong; Joseph W Hogan Journal: AIDS Patient Care STDS Date: 2008-01 Impact factor: 5.078
Authors: Roland C Merchant; Erin T Kelly; Kenneth H Mayer; Bruce M Becker; Susan J Duffy; David L Pugatch Journal: Pediatrics Date: 2008-06 Impact factor: 7.124