Few complete anti-HIV post-rape therapy
CHICAGO, IL, United States (UPI) -- Few adolescent victims of sexual assault complete treatment that can protect them from developing the sexually transmitted virus that causes AIDS.
Researchers looking over the charts of individuals who reported to emergency rooms after being raped found that of the 145 adolescents, ages 12 to 22, included in the study only 13 of the patients -- 15 percent -- completed the 28-day treatment.
The treatment has been shown to be effective in preventing infection with human immunodeficiency virus - the microbe that causes AIDS - among healthcare workers who suffer needlestick injuries.
Dr. Elyse Olshen, assistant clinical professor of pediatric emergency medicine at Columbia University, New York, said the results of her study 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,' Olshen said in the article in the Archives of Pediatric and Adolescent Medicine. About one in five victims, she reported, blacked out during the assault; about one in four can`t recall if the attacker used a condom and about half are unable to tell if the perpetrator ejaculated.
Of the 145 patients in the study, 129 were offered the treatment designed to prevent infection and 110 of the patients agreed to take it. Of the 86 patients who were referred for follow-up treatment only 37 returned for at least one visit.
Olshen noted that among the patients in the study, 46 percent had some form of psychiatric diagnosis, most frequently depression, substance abuse, bipolar disorder, suicidality or attention deficit disorders, a factor that might have a role in adherence to the prescribed therapy.
Olshen suggested that another reason for low adherence to the treatment was low prevalence of infections with the AIDS virus in the area. In fact, none of the assailants were known to be AIDS-infected and only about 2 percent were considered to be at risk of carrying the virus.
On the other hand, studies in areas such as Brazil and South Africa where AIDS is highly prevalent show that more than 50 percent of the patients complete the post-exposure prophylaxis treatment.
In an editorial that accompanied Olshen`s report, Dr. Jonathan Ellen, associate professor of medicine at the Johns Hopkins School of Medicine, Baltimore, advised that caution should be used in offering post-exposure prophylaxis to individuals who were unlikely to complete the course of treatment.
He voiced concern that incomplete use of the therapy could expose the patient to a greater risk of resistance to the virus if infection occurred, limiting future treatment options. Even though the patient may feel traumatized and in fear of contracting infection, 'These data support a restrained position,' he said in the journal to be published Tuesday by the American Medical Association.
'We agree with published recommendations that postexposure prophylaxis be offered to adolescent sexual assault survivors for exposures that pose a risk of HIV transmission,' Olshen said. 'Patient education and a comprehensive follow-up system with extensive outreach and case management are necessary to encourage adherence and return for follow-up care.' |
