1. Incidence and Prophylaxis of HIV Infection in Sexually Abused Children ChanthanaVitavasiri MD. Saowanee Kerdornfake MD. UbolChumjinda MattikaTapayantra ChutimaPantu

2. 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

3. Method 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,

4. Criteria 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

5. Results AgeERCounselBl.test 0-4464435 5-9989181 10-14425381341 Total569516457 %10090.6880.31 Children under 15 who came to verity, counsel and blood testing

6. AgeBl.testHBsAgHBsAbHIVAbVDRL 0-435-131- 5-981-221- 10-1434195021 Total45798541 %1001.9718.590.880.22 Initial Blood Testing 1 case VDRL-neg TPHA+ve

7. Rapist status

8. Time from sexual assault to Police General Hospital Time No.

9. Sexual assault verification result Type of positive finding No. PE=physical Examination PV= Pelvic Examination PR=Per Rectal Examination AP= Alkaline Phosphatase S = Sperm Normal PV,P R PE,PV, AP PV,AP, S PE,PR,AP PE,PV, AP PE,PV,A P,S

10. AgeBl.testARV28 days6 m FU 0-4358521 5-9812588137 10-1434111830102 Total45715143160 %10033.049.435.0 PEP children, complete ARV course, and 6 month follow up

11. HIV infected children A/0AgeDuratio n RapistRelationPEPVAPSHIVAb 0 HIVAb 6 m Mar.1, 00321Uncle-+--Pos Jun. 19, 00811Father----Pos Dec. 5, 001428 hr.3Acquaint ance ++--Negpos Apr.18, 01141 m1Father;s frieed -+--Pos *Sep 14, 01133-4 m1Neighbo ur -+--Pos *Rapist : pos HIVAb, HCVAb, HBsAb

12. Risk of HIV transmission 1. 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

13. Discussion Probability 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

14. Conclusion Incidence HIV infection in sexually abused children In the Police General Hospital 0.88%

15. Triple drugs prophylaxis should be considered in * HIV infected rapist * Anal exposure * More than one attacker * Seriously injured victims

16. Thank you