ED Pathway for Evaluation/Treatment of Children with Sexual Abuse Concerns

HIV Prophylaxis

HIV Risk Assessment Scale

Treatment Recommendations

Total Score by SART Team

Would offer PEP prior to consultation
Would not offer PEP prior to consultation

Total Score after S.I. Consultation

PEP offered after consultation
PEP not offered after consultation
Perpetrator: Score Patient: Score History as Reported by Patient: Score Examination Findings: Score
Known to be HIV positive 5 Does not recall events around assault 2 Reports history of penetration, with possible exposure of blood, semen, vaginal secretions, or rectal secretions to mucous membranes or non‐intact skin. 5 Acute vaginal or anal trauma 5
Unknown to patient 3 Unable to provide history due to development or preverbal 1 Does not report history of penetration, but reports possible exposure of blood, semen, vaginal secretions, or rectal secretions to mucous membranes or non‐intact skin. 4 Visible semen or other secretions in genital area 4
Known adult 2 Developmentally able to provide complete history 0 Reports exposure of urine, nasal secretions, saliva, sweat, or tears to skin or mucous membranes 0 Visible semen or other secretions on intact skin 1
Known adolescent 1     Reports exposure of blood, semen, vaginal secretions, or rectal secretions to intact skin 0 No visible secretions or acute injury 0
Known child 0     Reports contact that would not result in exposure to body fluids 0    
Behavioral concerns without disclosure 0     Denies sexual contact 0    

Prophylaxis is indicated if ≤ 72 hours from a high risk exposure from a known HIV source

Substantial Risk for HIV Exposure Negligible Risk for HIV Exposure

Exposure of

Vagina, rectum, eye, mouth
other mucous membrane, nonintact skin
percutaneous contact

Exposure of

Vagina, rectum, eye, mouth
other mucous membranes, intact or nonintact skin
percutanous contact

With

Blood, semen, vaginal secretions,
rectal secretions, breast milk,
any body fluid that is visibly contaminated
with blood

With

Urine, nasal secretions, saliva, sweat, or tears
if not visibly contaminated with blood

When

The source is known to be at high risk for HIV infection

Regardless

Of the known or suspected HIV status of the source

Consult with Rick Rutstein, M.D. for Case by Case Recommendations for Prophylaxis (Special Immunology beeper is backup for Dr. Rutstein)

Post-Exposure Prophylaxis: Laboratory Evaluation

Most Common Regimens Recommended

Age >13 years old who are Tanner 3 or higher
  • Raltegravir: One 400 mg tab BID PLUS
  • Tenofovir/Emtricitabine(Truvada) 300/200 mg tab once daily
    If patient has history of renal disease, replace Truvada with Combivir 150/300mg BID
Age 6-12 years old who are greater than 30kg and CAN swallow whole tabs/caps OR
Age >13 years old who are less than Tanner 3
  • Raltegravir: 400 mg BID PLUS Lamivudine/Zidovudine* (Combivir) 150/300 mg BID
  • *For patients with severe anemia or neutropenia page SI doc on call to discuss alternative to Zidovudine
Age 2-12 years old who are less than 30kg OR children who CANNOT swallow whole tabs/caps
  • Lamivudine: 4mg/kg/dose BID formulation is 10mg/ml AND
  • Zidovudine: 240mg/m2/dose BID formulation is 10mg/ml PLUS
  • Raltegravir Chewable Tabs (see dosing table below)
  • OR
  • Lamivudine: 4mg/kg/dose BID formulation is 10mg/ml OR
  • Zidovudine: 240mg/m2/dose BID formulation is 10mg/ml PLUS
  • Kaletra (lopinavir/ritonavir): 300mg/m2/dose BID formulation is (80mg/20mg)/ml

Raltegravir Dosing

Raltegravir chewable tabs come as 25mg and 100 mg. Maximum dose of Raltegravir chewable tabs is 300mg BID, but the maximum dose of the Raltegravir film coated tabs is 400mg BID. To note Raltegravir 400mg film coated tab BID can be given to pts >25kg but for ease of dosing will give only for pts >30kg as noted in the above algorithm.

Weight Dosing
10 - 14kg 75mg BID
14 - 20kg 100mg BID
20 - 28kg 150mg BID
28 - 40kg 200mg BID
>40kg 300mg BID

 

For questions, page Special Immunology doctor on call.

For more information on the medications listed above, please go to AIDSinfo Drug Database.