HIV Prophylaxis after sexual assault: Should I advise it?

18 Jun

  Risk for HIV transmission from receptive vaginal intercourse is 0.1-0.2%; rectal intercourse 0.5-3%

 *   Assess the assailant’s risk factors for HIV infection (if possible)

  • Man who has sex with other men
  • Injecting drug or crack cocaine user

*   When assailant’s HIV status is unknown, factors for determining increased risk include:

  • Whether vaginal/anal penetration occurred
  • whether ejaculation occurred on mucous membranes
  • whether multiple assailants were involved
  • whether mucosal lesions are present on the survivor

*   Following information should be discussed with the patient:

  • Unproven benefit of prophylaxis (no evidence to justify use, only extrapolation from occupational exposure studies; unknown success rate)
  • Known toxicities of the drugs (GI upset, elevated transaminases, renal failure, feeling poorly, nausea/vomiting, flu-like illness, vivid dreams)
  • Necessity of close follow-up
  • Necessity of adherence to dosing schedule
  • Necessity of early initiation of therapy (within 72 hours of exposure)

*   Specialist consultation with Infectious Disease is recommended

*  Ultimate decision should be made after discussion between yourself, the specialist, and the patient

*   If the patient does choose to start antiretroviral therapy, they should be given only ~1 weeks worth of medication as to ensure they will be seen for adequate follow-up within 1 week

*   HIV antibody test should be done at the time of assessment, repeat at 6 weeks, 3 months, and 6 months

Submitted by W. Brooks.
Reference(s): CDC website


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