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HIV prophylaxis after sexual assault

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Among healthcare workers exposed to risk of HIV infection as a result of needlestick injury post-exposure prophylaxis (PEP) with zidovudine reduced seroconversion by 80%. In 1998 the New York State Department of Health issued guidelines recommending HIV PEP for all victims of sexual assault involving vaginal or anal intercourse who presented within 36 hours and whose assailant was either HIV infected or of unknown HIV status. Current practise for female adolescents presenting to a New York City paediatric emergency department after sexual assault has been reported.

A retrospective search for the two year period January 1999 to December 2000 identified 25 patients who attended the paediatric emergency department after sexual assault. Fourteen adolescent females, all of whom had suffered vaginal intercourse, had received HIV PEP. In addition, one 15 year old declined HIV PEP and two patients aged 13 and 14 were asked to attend follow up for discussion of HIV PEP.

The 14 patients who received HIV PEP ranged in aged from 12 to 19 years and 12 were 15 years or older. Nine knew their attacker but none knew his HIV status. Four had also suffered oral sex and two anal. Two of the men had used a condom. The time from assault to presentation ranged from three to 72 hours and six patients presented later than 24 hours. They received the PEP an average of 58 minutes after presentation, one with zidovudine alone and the rest with three drugs including either zidovudine and lamivudine (12) or stavudine and lamivudine (1) with either nelfinavir (9) or indinavir (4). Thirteen patients accepted prophylaxis against chlamydia and gonorrhoea and 12 took emergency contraception. There was no follow up.

The authors of this paper suggest that provision of HIV PEP in the emergency department should be expedited through education of medical staff about HIV PEP and by making the appropriate drugs available for immediate dispensing in the department.

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