Teen sexual assault survivors seldom complete HIV prevention therapy

July 03, 2006

Fewer than one-half of adolescent sexual assault survivors who are prescribed medications to prevent contraction of human immunodeficiency virus (HIV) may return for follow-up visits and only about 15 percent complete the therapy, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

As many as 10 percent of adolescent females experience sexual assault in their lifetimes, according to background information in the article. The risk of contracting HIV after a single exposure is low, but transmission has been reported after sexual assault. National guidelines published in 2005 recommend that physicians consider prescribing a 28-day course of antiviral medications after sexual assault to reduce the risk of contracting HIV, an extension of a practice first used by health care workers exposed to the virus by needle sticks.

Elyse Olshen, M.D., M.P.H., then at Boston University School of Medicine and now at Columbia University Medical Center, New York, and colleagues reviewed the charts of 145 adolescents ages 12 to 22 years who visited one of two pediatric emergency departments in Boston within 72 hours of a sexual assault. During the years of the study--2001 to 2003--both academic medical centers followed protocols directing that medications to prevent HIV be considered on a case-by-case basis following sexual assault and that adolescents prescribed these therapies visit their primary care providers or follow-up clinics for continuing treatment.

Of the 145 adolescents, 129 (89 percent) were offered prophylactic (preventive) therapy and 110 (76 percent) agreed to take it. Of the 86 of those 110 who were referred for follow-up treatment at one of the two hospitals in the study, only 37 (38 percent) returned for at least one follow-up visit and 13 (15 percent) completed the full 28 days of prophylactic therapy.

The results highlight the difficulties associated with prescribing such therapies to adolescent sexual assault survivors, including the challenge of determining which survivors should receive a prescription. "In many cases of adolescent sexual assault, the risks of HIV transmission cannot be determined," the authors write. "Among patients in our study, 21 percent reported having blacked out during the assault, 54 percent were unsure whether ejaculation had occurred and 27 percent were unsure whether a condom had been used." In addition, many teen sexual assault survivors also have psychiatric conditions that may decrease the likelihood that they will adhere to prophylactic therapy.

"We agree with published recommendations that postexposure prophylaxis be offered to adolescent sexual assault survivors for exposures that pose a risk of HIV transmission," the authors conclude. "Patient education and a comprehensive follow-up system with extensive outreach and case management are necessary to encourage postexposure prophylaxis adherence and return for follow-up care among adolescent sexual assault survivors."
(Arch Pediatr Adolesc Med. 2006;160:674-680. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Aerosmith Endowment Fund for the Prevention and Treatment of HIV, Leadership Education in Adolescent Health Project, Maternal and Child Health Bureau, U.S. Department of Health and Human Services, and the Boston University School of Medicine Summer Research Scholarship Program.

Editorial: Use HIV Preventive Therapy Judiciously

Given the lack of adherence to HIV prophylactic therapy demonstrated in this and other studies, the risks of viral resistance associated with failure to finish the course of treatment may outweigh the benefits of these medications for many adolescent sexual assault victims, writes Jonathan M. Ellen, M.D., The Johns Hopkins School of Medicine, in an accompanying editorial.

"Although the saliency of HIV is great and the desire to offer treatment with any hope of benefit to someone traumatized by sexual assault is high, data support a restrained position," Dr. Ellen concludes.

(Arch Pediatr Adolesc Med. 2006;160:754-755. Available pre-embargo to the media at www.jamamedia.org.)

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org. To contact editorialist Jonathan M. Ellen, M.D., call Katerina Pesheva at 410-516-4996 or Kim Hoppe at 410-516-4934.

The JAMA Network Journals

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.