Abstract 456

Background: The use of antiretroviral PEP in non-occupational settings after accidental needlestick injuries or sexual assault is not well studied. Limited information is available about the use of PEP in potential HIV exposures in children and adolescents

Objective: To describe the current experience with HIV PEP use in children and adolescents.

Methods: Retrospective review of all children and adolescents offered HIV PEP over an 18 month period between 1/97 and 6/98 at an urban academic teaching hospital.

Results: Ten pediatric and adolescent patients were offered HIV PEP, 6 patients after sexual assault, 4 patients after needle stick injuries. There were two children (2 and 3 years old) and 8 adolescents (14 to 20 years old). Of these 10 patients 8 were started on HIV PEP. The regimens used in PEP were zidovudine, epivir and indinavir in 7 patients and zidovudine, epivir and nelfinavir in one patient. All 10 patients were HIV negative by serology at baseline testing, and those available for follow up remained HIV negative over a 3 to 12 month period. Only 2 patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues and parental support played a role whether PEP and follow up was completed or not.

Conclusions: HIV PEP in potential non-occupational exposures in children and adolescents presents a medical challenge and requires a coordinated effort at the initial presentation and at follow up. Factors to be considered prior to instituting PEP and determining drug regimens should include an assessment of HIV risk, financial and psychosocial issues and the potential side effects of antiretroviral medications. Pediatric guidelines for HIV PEP need to be developed.