Prophylaxis against possible human immunodeficiency virus exposure after nonoccupational needlestick injuries or sexual assaults in children and adolescents.
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.


METHODS
Survey.


METHODS
Directors of all PID and PEM departments with fellowship programs in the United States and Canada between July and November 1998.


METHODS
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.
Babl
F E
FE
Division of Pediatric Infectious Diseases, Finland 5, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA. franz.babl@bmc.org
Cooper
E R
ER
Kastner
B
B
Kharasch
S
S
D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002650:Child Abuse, Sexual; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D008297:Male; D016602:Needlestick Injuries; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
D019380:Anti-HIV Agents