HIV postexposure prophylaxis for children and adolescents

HIV postexposure prophylaxis (PEP) is now a well-established part of the ma nagement of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use i n nonoccupational settings remains controversial with limited data availabl e, There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault, T he objective was to describe the current practice of and associated problem s with HIV PEP far children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescent s offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual ass ault, four patients after needle stick injuries. There were two small child ren 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lam ivudine, and indinavir were prescribed for in seven patients and zidovudine , lamivudine, and nelfinavir for one other. All 10 patients were HIV negati ve by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients complet ed the full course of 4 weeks of antiretroviral therapy. Financial concerns , side effects, additional psychiatric and substance abuse issues as well a s the degree of parental involvement influenced whether PEP and clinical fo llow-up was completed, HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system a nd at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis, A provisional managem ent approach to HIV PEP in children and adolescents is proposed, (Am J Emer g Med 2000;18:282 287. Copyright (C) 2000 by W.B, Saunders Company).