July 3, 2006

Teen Sex Assault Victims Rarely Finish HIV Meds

NEW YORK (Reuters Health) - Findings from a new study suggest that just 15 percent of adolescents who have been sexually assaulted and started anti-HIV postexposure prophylaxis (PEP) actually complete the recommended 28-day course of treatment.

"The use of PEP in this population can be difficult because of patient uncertainty regarding exposure, high rates of psychiatric comorbidity, and low rates of follow-up," Dr. Elyse Olshen, from Columbia University in New York, and colleagues note.

PEP is often advised when someone thinks they may have been exposed to HIV through sex.

The study, in the Archives of Pediatrics & Adolescent Medicine for July, involved 145 adolescent patients who were seen at one of two urban emergency departments within 72 hours of a sexual assault.

Ninety-six percent of patients were female; 37 percent were white, 38 percent black, 14 percent Hispanic, and 10 percent were of other ethnic background, the authors note.

Uncertainty regarding exposure was a common theme among the study group. Twenty-seven percent of subjects did not know if a condom had been used, 54 percent were uncertain if ejaculation had occurred, and 21 percent reported blacking out during the incident.

PEP was offered to 129 subjects and 110 agreed to use it, the report indicates. Of the 86 patients who begun PEP and were seen for follow-up, just 13 completed the full course.

Nearly half of patients who used PEP and returned for follow-up experienced an adverse reaction.

Psychiatric comorbidity was seen in 47 percent of the assault victims and, as noted, was associated with lower adherence to PEP.

"We agree with published recommendations that PEP be offered to adolescent sexual assault survivors for exposure that pose a risk of HIV transmission. Patient education and a comprehensive follow-up system with extensive outreach and case management are necessary to encourage PEP adherence and return for follow-up care among adolescent sexual assault survivors," the authors conclude.

SOURCE: Archives of Pediatrics and Adolescent Medicine July 2006.