Abstract 457 Poster Session III, Monday, 5/3 (poster 223)

Background: The use of antiretroviral PEP after non-occupational exposure to HIV remains controversial. Data regarding the efficacy of antiretroviral prophylaxis in this setting are lacking.

Objective: We attempted to determine expert opinion and current clinical practice in hospitals with pediatric emergency medicine (ED) and /or pediatric infectious diseases (ID) programs.

Methods: A survey was mailed to directors of all ED and ID programs in the US and Canada between 7/98 and 11/98. Scenarios of non-occupational needlestick and sexual assault were followed by questions regarding management of HIV exposure.

Results: 97 of 134 (72%) surveys were returned after 2 mailings. Few ED responders were aware of protocols at their institution (25% for needlestick, 11% for sexual assault, 30% unsure). ED responders were less likely than their ID counterparts to be comfortable with decisions regarding HIV PEP (39% vs 79%). ID responders were more likely to have ever recommended or offered HIV PEP than the ED responders (57% vs 22% for needlestick, 23% vs 11% for sexual assault). ID responders were more likely to recommend or offer HIV PEP in the first 24 hours after the incidence in the scenarios presented than ED responders (80% vs 55% for needlestick, 67% vs 50% for sexual assault). If HIV PEP was prescribed, there was variation among the responders regarding which and how many antiretroviral agents to use (Table 1).

Table 1 No caption available.
Full size table

Conclusions: There is no consistent approach after potential non-occupational exposure to HIV. Although ID responders were more comfortable making decisions than ED responders, there was considerable variation regarding regimens and indications for HIV PEP. In both needlestick and sexual assault scenarios ED and ID responders would offer or recommend HIV PEP at high rates. Studies to determine HIV risk and HIV PEP efficacy in the non-occupational setting are needed to develop national guidelines.