Babl F E, Cooper E R, Damon B, Louie T, Kharasch S, Harris J A
Division of Pediatric Emergency Medicine, Boston University School of Medicine, Boston Medical Center, MA 02118, USA.
Am J Emerg Med. 2000 May;18(3):282-7. doi: 10.1016/s0735-6757(00)90123-2.
HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.
HIV暴露后预防（PEP）现已成为医护人员职业暴露于HIV后管理工作中既定的一部分。在非职业环境下，对性接触或注射吸毒后暴露于HIV的成年人使用PEP仍存在争议，可用数据有限。关于儿童和青少年在意外针刺伤或性侵犯后进行HIV PEP的信息更少。目的是描述城市学术性儿科急诊科针对儿童和青少年进行HIV PEP的当前做法及相关问题。对1997年6月至1998年6月期间所有接受HIV PEP的儿童和青少年进行了回顾性研究。有10名儿科和青少年患者接受了HIV PEP，其中6名是性侵犯后，4名是针刺伤后。有两名2岁和3岁的幼儿以及八名青少年。在这10名患者中，有8名开始接受HIV PEP。用于PEP的方案各不相同；7名患者使用齐多夫定、拉米夫定和茚地那韦，另一名患者使用齐多夫定、拉米夫定和奈非那韦。所有10名患者在基线检测时血清学HIV均为阴性，所有可进行随访检测的患者（10名中的5名）在4至28周时仍为HIV阴性。只有两名患者完成了为期4周的抗逆转录病毒治疗全疗程。经济问题、副作用、额外的精神问题和药物滥用问题以及家长参与程度影响了PEP和临床随访是否完成。儿童和青少年在非职业环境下的HIV PEP带来了医疗和管理挑战，在初次就诊于医疗系统时以及随访时都需要协调努力。在开始预防之前，需要考虑我们系列研究中患者所遇到的困难。本文提出了一种针对儿童和青少年HIV PEP的临时管理方法。
