Post-Exposure Prophylaxis (PEP) for Sexual Assault Survivors

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Post-exposure prophylaxis for sexual assault survivors

Post-exposure prophylaxis

Loutfy MR, Macdonald S, Myhr T, Husson H, Du Mont J, Balla S,

u T, Rachlis A.

Prospective cohort study of HIV post-exposure

prophylaxis for sexual assault survivors. Antivir Ther. 2008;13(1):87-

95

There is a lack of standardized programs for HIV counselling and post-

exposure prophylaxis (PEP) in the setting of sexual assault.

Loutfy and associates conducted an 18-month prospective cohort study

assessing universal HIV counselling for all sexual assault survivors

presenting to 18 Ontario Sexual Assault Treatment Centres.

HIV PEP was universally offered to those at risk of HIV infection (high risk or

unknown risk) presenting < or =72 h after the assault, using Combivir

(Lamivudine/Zidovudine) one pill and Kaletra

(Lopinavir/Ritonavir) three capsules twice a day for 28 days.

Those who accepted HIV PEP were monitored via a schedule of frequent follow ups.

The primary outcomes were acceptance and completion rates, and

their predictors were determined using multivariable logistic

regression. Adverse events were categorized using a standardized

toxicity grading system.

Of the 900 evaluable participants eligible for PEP, 798 (69 at high risk and 729

at unknown risk) were offered treatment. Acceptance rates were 66.7% (n=46) and

41.3% (n=301) for participants at high risk and unknown risk, respectively.

Participants at high risk were 2.2 times more likely to accept PEP

than those at unknown risk (adjusted odds ratio 2.2; 95% confidence

interval 1.2-4.0; P=0.01). Overall, 23.9% high-risk (n=11) and 33.2%

unknown-risk participants (n=100) completed PEP (P=0.20).

Predictors of acceptance and completion included assault by a stranger and

participant anxiety. Adverse events were common, with 77.1% of participants

reporting grade 2-4 symptoms. A province-wide

standardized program of universal HIV counselling and offering of PEP

to sexual assault survivors with frequent follow up was successfully

implemented and feasible.

Editors´note: Post-exposure prophylaxis for sexual assault survivors

requires contact with the health system within 72 hours of the

attack, availability of antiretroviral drugs and willingness to take

them, and, in most cases, consent for HIV testing and counselling.

Both anxiety and perceived risk that the assailant could have been

HIV-positive influence uptake and completion, but so do side effects.

Only 32% of those who started on post-exposure prophylaxis actually

finished the 28-day course.

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