• Post sexual-exposure prophylaxis with HAART after sexual assaults (Poster, WePeC4313)
  Authored by O. Launay, A. Soussy, M. Aubert

A study in France of PEP administered less than 48 hours after sexual assault, defined as oral, vaginal and/or rectal penetration, was performed in a French city from February through October, 1999. A regimen of d4T, 3TC, and nelfinavir was given twice a day for a minimum of three days, which could then be extended to four weeks of therapy. The alleged perpetrator was asked to consent to HIV testing.

Of 216 assaults reported during these eight months, 135 were rapes. Sixty percent were not offered PEP, primarily because the assault was reported more than 48 hours later. Of the remaining 54 cases, 52 were female and 13 occurred in children between 4-17 years old; three assault victims refused PEP. Only 69% returned for the three-day follow-up visit, and participation fell off steeply after that, with only 24% appearing for the last follow-up visit three months later. No one became HIV-positive and 76% discontinued PEP before four weeks. Nine percent had drug toxicity, which led to discontinuation of PEP by four individuals. The justice system only encouraged attackers to be tested for HIV during the last four months of the study. Nine of 24 agreed to testing, and all were HIV-negative.

Administration of PEP in any circumstances is hampered by the need to initiate therapy as soon as possible in order for it to be effective. Particularly in the case of sexual assault, this will require active participation by the police, the judiciary, and the perpetrator.