Incidence and Prophylaxis of Incidence and Prophylaxis of HIV Infection in Sexually HIV Infection in Sexually

Abused ChildrenAbused ChildrenChanthana Vitavasiri MD.

Saowanee Kerdornfake MD.

Ubol Chumjinda

Mattika Tapayantra

Chutima Pantu

Objective

1. To obtain the incidence of HIV

infection in sexually abused children

2. To study post-exposure prophylaxis

and follow up for rape victims

MethodMethod

•Counseling

•Physical Examination•Pelvic or Rectal Examination•Blood testing•Follow up

Jan 2000 -Dec 2001,children below 15 years of age, who came to verify

sexual abuse were offered,

Criteria for HIV prophylaxisCriteria for HIV prophylaxis

1. Status HIVAb negative

2. Verify sexual assault

3. Come to the hospital within 72 hours

4. Rapist’s status HIVAb positive, high

risk profile

5. Agree or consent to follow up

Results

Age ER Counsel Bl.test

0-4 46 44 35

5-9 98 91 81

10-14 425 381 341

Total 569 516 457

% 100 90.68 80.31

Children under 15 who came to verity,

counsel and blood testing

Age Bl.test HBsAg HBsAb HIVAb VDRL

0-4 35 - 13 1 -

5-9 81 - 22 1 -

10-14 341 9 50 2 1

Total 457 9 85 4 1

% 100 1.97 18.59 0.88 0.22

Initial Blood Testing

1 case VDRL-neg TPHA+ve

Rapist statusRapist status

11%

19%13%

6%

13%

35%1%

2% BoyfriendRelativeAcquiantaceStrangerNeighbourFather's friendOtherNo reply

Time from sexual assault to Time from sexual assault to Police General HospitalPolice General Hospital

Time

No.

54

2518

43

52 3367

188

350

50

100

150

200

day 1 day 2 day 3 day 4-7 day >7 No reply

0-6 hr. 7-12 hr. 13-18 hr. 19-24 hr

Sexual assault verification Sexual assault verification resultresult

Type of positive finding

No.

326

70

232

185

0

50

100

150

200

250

PE=physical ExaminationPV= Pelvic ExaminationPR=Per Rectal ExaminationAP= Alkaline PhosphataseS = Sperm

NormalPV,PR

PE,PV,APPV,AP,SPE,PR,AP

PE,PV,AP

PE,PV,AP,S

Age Bl.test ARV 28 days 6 m FU

0-4 35 8 5 21

5-9 81 25 881 37

10-14 341 118 30 102

Total 457 151 43 160

% 100 33.04 9.4 35.0

PEP children, complete ARV PEP children, complete ARV course, and 6 month follow upcourse, and 6 month follow up

HIV infected childrenHIV infected childrenA/0 Age Duratio

nRapist Relation PE PV AP S HIVAb

0

HIVAb

6 m

Mar.1, 00 3 2 1 Uncle - + - - Pos Pos

Jun. 19, 00 8 1 1 Father - - - - Pos Pos

Dec. 5, 00 14 28 hr. 3 Acquaintance

+ + - - Neg pos

Apr.18, 01 14 1 m 1 Father;s frieed

- + - - Pos Pos

*Sep 14, 01 13 3-4 m 1 Neighbour

- + - - Pos Pos

*Rapist : pos HIVAb , HCVAb , HBsAb

Risk of HIV transmission1. Virus (Viral load,Virulence,Resistant strain)

2. Route (Anal,Vaginal,Oral)

3. Ulcerative or Inflammation

4. Trauma, Bleeding

5. Times

6. Others; Menstruation, IUD Circumcision

DiscussionDiscussionProbability of transmission of HIV

from single exposure

Percutaneous Exposure

Receptive anal

Insertive anal

Receptive vaginal

Insertive vaginal

Receptive fellalio with ejaculation

0.0032

0.008 - 0.032

0.006

0.0005 - 0.0015

0.0003 - 0.0009

0.0004

ConclusionConclusionIncidence HIV infection in sexually abused childrenIn the Police General Hospital 0.88%

Triple drugs prophylaxis should be considered in

* HIV infected rapist* Anal exposure

* More than one attacker* Seriously injured victims

Thank you