Postexposure Prophylaxis Should Not Be ‘Automatic’ Response for Children Exposed to HIV, Clinical Report Says
All children who are exposed to HIV should not "automatically" receive antiretroviral drugs for postexposure prophylaxis, or PEP, and health care providers should consider "whether the risk of infection is greater than the risks associated with taking the drugs," according to a clinical report in the June issue of the journal Pediatrics, Reuters Health reports (McCook, Reuters Health, 6/2). Dr. Peter Havens of the Medical College of Wisconsin and colleagues of the American Academy of Pediatrics Committee on Pediatric AIDS conducted a literature review to examine the issues surrounding HIV exposure among children and adolescents and to provide PEP recommendations for such situations. Although the U.S. Public Health Service has published guidelines for PEP for occupational and nonoccupational exposures, the recommendations do not address situations unique to children, such as exposure to breastmilk from an HIV-positive woman or a puncture wound from a needle found on a playground. Because antiretroviral drugs used for PEP can cause "significant toxicity," the choice to start PEP should be made "in consultation with the patient, the family and a clinician with experience in treatment of persons with HIV infection." If begun, PEP should be initiated "as soon as possible" -- within 72 hours -- to the time of exposure and continued for 28 days, the committee states. Health care workers should provide instructions on how to prevent secondary transmission and conduct follow-up visits to address emotional support, medication adherence, toxicity monitoring and serial HIV antibody testing if necessary (Havens et al., Pediatrics, June 2003). Havens said that antiretroviral drugs are expensive and can "cause a host" of side effects, according to Reuters Health. He added, "There's no reason to do all of that if you're not really at risk of HIV. So when you get right down to it, the number of times that this would be recommended in actual practice is quite low" (Reuters Health, 6/2).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.