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Prophylaxis Against Possible Human Immunodeficiency Virus Exposure After Nonoccupational Needlestick Injuries or Sexual Assaults in Children and Adolescents
Franz E. Babl, MD, MPH;
Ellen R. Cooper, MD;
Beth Kastner, MPH;
Sigmund Kharasch, MD
Arch Pediatr Adolesc Med. 2001;155:680-682.
Background Nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis
(PEP) for adults has been described, although the Centers for Disease Control
and Prevention, Atlanta, Ga, offer no specific recommendations. There is limited
information about its use in children and adolescents.
Objective To describe the current practices of physicians in pediatric infectious
disease (PID) and pediatric emergency medicine (PEM) departments regarding
nonoccupational HIV PEP for children and adolescents.
Design Survey.
Participants Directors of all PID and PEM departments with fellowship programs in
the United States and Canada between July and November 1998.
Main Outcome Measures General questions regarding HIV PEP and questions concerning 2 scenarios
(5-year-old with a needlestick injury and a 15-year-old after sexual assault).
Results The return rate was 67 (78%) of 86 for PID and 36 (75%) of 48 for PEM
physicians. Fewer than 20% of physicians reported institutional policies for
nonoccupational HIV PEP; 33% had ever initiated nonoccupational HIV PEP. In
both scenarios, PID physicians were more likely than PEM physicians to recommend
or offer HIV PEP in the first 24 hours after the incident (55 [83%] of 66
vs 20 [56%] of 36 for needlestick injuries [odds ratio, 4.0; 95% confidence
interval, 1.6-10.1] and 47 [72%] of 65 vs 16 [50%] of 32 for sexual assault
[odds ratio, 2.6; 95% confidence interval, 1.1-6.3]). Seven different antiretroviral
agents in single, dual, or triple drug regimens administered for 2 to 12 weeks
were suggested.
Conclusions Although few physicians reported institutional policies, and only one
third had ever initiated HIV PEP, many would offer or recommend HIV PEP for
children and adolescents within 24 hours after possible HIV exposure. A wide
variation of regimens have been suggested. There is a need for a national
consensus for nonoccupational HIV PEP.
From the Divisions of Pediatric Emergency Medicine (Drs Babl, Kastner,
and Kharasch) and Pediatric Infectious Diseases (Drs Babl and Cooper), Boston
University School of Medicine, Boston Medical Center, Boston, Mass.
Corresponding author and reprints: Franz E. Babl, MD, MPH, Division
of Pediatric Infectious Diseases, Finland 5, Boston Medical Center, 1 Boston
Medical Center Place, Boston, MA 02118 (e-mail: franz.babl{at}bmc.org).
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