Use of human immunodeficiency virus postexposure prophylaxis in adolescent sexual assault victims

Objectives: To describe the use of human immunodeficiency virus (HIV) postexposure prophylaxis ( PEP) in adolescent survivors of sexual assault and to explore barriers to PEP completion in this population. Design: Chart review. Setting: Two academic medical centers in Boston, Mass, between July 1, 2001, and June 30, 2003. Participants: Adolescents presenting to 2 urban pediatric emergency departments within 72 hours of a penetrating sexual assault. Of 177 charts reviewed, adequate documentation of the sexual assault and medical management was available for 145 patients. Intervention: Provision of HIV PEP. Main Outcome Measure: Documented completion of a 28-day course of PEP. Results: Among the 145 patients, 96% were female, 38% were black, and 14% were Hispanic. Many patients were uncertain regarding their exposures: 27% were unsure whether a condom had been used, 54% were unsure whether ejaculation had occurred, and 21% had blacked out during the assault. One hundred ten (76%) received HIV PEP. Of the 97 patients referred for follow-up at the academic centers, 37 returned for at least 1 visit and 13 completed a 28-day course of PEP. Sixteen (46%) of those taking PEP who returned for follow-up developed an adverse reaction to medication. Forty-seven percent of adolescent sexual assault survivors had carried a psychiatric diagnosis before the assault; adherence to PEP was lower among these adolescents. Conclusions: We observed low rates of PEP completion among adolescent sexual assault survivors. Potential difficulties of using PEP in this population include uncertainties regarding exposure, high rates of psychiatric comorbidity, and low rates of return for follow-up care.