AIDSWEEKLY Plus; Monday, September 12, 2005
Staff Medical Writers

"Although rare, HIV transmission is one of the most feared consequences of sexual assault. While availability of medications to prevent HIV transmission (HIV nonoccupational postexposure prophylaxis [HIV nPEP]) is increasing, little is known about emergency department (ED) prescribing practices and patient adherence to treatment recommendations.

"To determine factors associated with offering, following up with, and adhering to treatment when HIV nPEP is initiated for sexual assault victims. This was a retrospective chart review of female patients presenting with complaint of sexual assault to an urban ED from October 1, 1999, to September 30, 2002," investigators in the United States report.

"HIV nPEP medications and/or follow-up were provided without charge. Chi-square analysis identified factors associated with being offered or referred for nPEP and follow-up. Variables significant at the p<0.10 level were entered into logistic regression analysis. Two hundred twenty-nine charts were reviewed. The final sample size was 181.

"Mean age was 29.1 years; median time from assault to presentation was 10.1 hours; 51.5% of the assailants were known to the victims. HIV nPEP was offered to 89 (49%) patients, and 11 patients were referred to an HIV nurse. Eighty-five (85%) patients accepted, 38 of these 85 (45%) followed up, and 18 of the 85 (21%) completed treatment," wrote J.A. Linden and colleagues at Boston University.

"In multivariate analysis," researchers said, "three variables were statistically significantly associated with increased likelihood of referral or being offered HIV nPEP: unknown assailant, having insurance, and younger age. Treatment was completed by 15 of 82 (18%) of ED-initiated patients, versus 3 of 3 (100%) referred for initiation."

Linden concluded, "The authors were unable to identify factors associated with completing treatment. HIV nPEP was offered to less than half of sexual assault patients, and few completed treatment. Further studies are needed to evaluate and improve appropriateness of HIV nPEP administration and follow-up."

Linden and colleagues published their study in Academic Emergency Medicine (HIV postexposure prophylaxis in sexual assault: Current practice and patient adherence to treatment recommendations in a large urban teaching hospital. Acad Emerg Med. 2005 Jul;12(7):640-6.

For additional information, contact J.A. Linden, Boston University, School of Medicine, Boston Medical Center, Dept. Emergency Med, Dowling 1 S, 818 Harrison Avenue, Boston, MA 02118, USA.

The publisher of the journal Academic Emergency Medicine can be contacted at: Hanley & Belfus Inc., 210 S 13th St., Philadelphia, PA 19107, USA.

Keywords: Boston, Massachusetts, United States, HIV/AIDS, Emergency Department, Postexposure Prophylaxis, Sexual Assault.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Linden JA, Oldeg P, Mehta SD, et al. HIV postexposure prophylaxis in sexual assault: current practice and patient adherence to treatment recommendations in a large urban teaching hospital, Acad Emerg Med. 2005 Jul;12(7):640-6.

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