Teen Sex Assault Victims Rarely Finish HIV Meds

In a recent study, only 15 percent of adolescents who were put on HIV postexposure prophylaxis (PEP) after a sexual assault completed the recommended 28-day treatment course. "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 of Columbia University and colleagues noted.

The researchers studied 145 adolescent patients seen at two urban emergency departments within 72 hours of sexual assault. Ninety-six percent of the patients were female; 37 percent were white, 38 percent black, 14 percent Hispanic and 10 percent of other ethnic backgrounds. Uncertainty regarding exposure was common among the study group. Twenty-seven percent did not know whether a condom had been used, and 54 percent were unsure if ejaculation had occurred. Twenty-one percent reported passing out during the assault.

The study showed PEP was offered to 129 subjects, and 110 agreed to use it. But of the 86 patients who began PEP and were seen for follow-up, only 13 completed the full course of treatment. Nearly half the patients who used PEP and returned for follow-up reported an adverse reaction. Psychiatric comorbidity, which was seen in 47 percent of the assault victims, was associated with lower adherence to PEP.

"We agree with published recommendations that PEP be offered to adolescent sexual assault survivors for exposure[s] 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 concluded.

The study, "Use of Human Immunodeficiency Virus Postexposure Prophylaxis in Adolescent Sexual Assault Victims," appeared in the Archives of Pediatric & Adolescent Medicine (2006;160(7):669-758).

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