Havens Peter L
Pediatrics. 2003 Jun;111(6 Pt 1):1475-89. doi: 10.1542/peds.111.6.1475.
Exposure to human immunodeficiency virus (HIV) can occur in a number of situations unique to, or more common among, children and adolescents. Guidelines for postexposure prophylaxis (PEP) for occupational and nonoccupational (eg, sexual, needle-sharing) exposures to HIV have been published by the US Public Health Service, but they do not directly address nonoccupational HIV exposures unique to children (such as accidental exposure to human milk from a woman infected with HIV or a puncture wound from a discarded needle on a playground), and they do not provide antiretroviral drug information relevant to PEP in children. This clinical report reviews issues of potential exposure of children and adolescents to HIV and gives recommendations for PEP in those situations. The risk of HIV transmission from nonoccupational, nonperinatal exposure is generally low. Transmission risk is modified by factors related to the source and extent of exposure. Determination of the HIV infection status of the exposure source may not be possible, and data on transmission risk by exposure type may not exist. Except in the setting of perinatal transmission, no studies have demonstrated the safety and efficacy of postexposure use of antiretroviral drugs for the prevention of HIV transmission in nonoccupational settings. Antiretroviral therapy used for PEP is associated with significant toxicity. The decision to initiate prophylaxis needs to be made in consultation with the patient, the family, and a clinician with experience in treatment of persons with HIV infection. If instituted, therapy should be started as soon as possible after an exposure-no later than 72 hours-and continued for 28 days. Many clinicians would use 3 drugs for PEP regimens, although 2 drugs may be considered in certain circumstances. Instruction for avoiding secondary transmission should be given. Careful follow-up is needed for psychologic support, encouragement of medication adherence, toxicity monitoring, and serial HIV antibody testing.
儿童和青少年接触人类免疫缺陷病毒（HIV）的情况可能发生在一些特定或更为常见的独特场景中。美国公共卫生服务部已发布针对职业和非职业（如性接触、共用针头）暴露于HIV后的暴露后预防（PEP）指南，但这些指南并未直接涉及儿童特有的非职业性HIV暴露（如意外接触感染HIV的女性的母乳或在操场上被丢弃针头刺伤），也未提供与儿童PEP相关的抗逆转录病毒药物信息。本临床报告回顾了儿童和青少年潜在暴露于HIV的相关问题，并针对这些情况给出PEP建议。非职业性、非围产期暴露导致HIV传播的风险通常较低。传播风险会因与暴露源和暴露程度相关的因素而有所改变。可能无法确定暴露源的HIV感染状况，且可能不存在按暴露类型划分的传播风险数据。除围产期传播情况外，尚无研究证明在非职业环境中暴露后使用抗逆转录病毒药物预防HIV传播的安全性和有效性。用于PEP的抗逆转录病毒疗法具有显著毒性。启动预防措施的决定需要与患者、其家人以及有治疗HIV感染患者经验的临床医生协商后做出。如果进行预防，应在暴露后尽快开始治疗——不迟于72小时——并持续28天。许多临床医生会在PEP方案中使用三种药物，不过在某些情况下也可考虑使用两种药物。应给予避免二次传播的指导。需要进行仔细的随访，以提供心理支持、鼓励坚持用药、监测毒性以及进行系列HIV抗体检测。
