Counseling and Testing for Human Immunodeficiency Virus

The true risk of contracting human immunodeficiency virus (HIV) from a single sexual encounter is unknown but believed to be rare. Estimated rates are felt to be highest with receptive, unprotected anal intercourse (0.008 to 0.032 infections per episode with an HIV positive partner). The risk with receptive vaginal intercourse is 0.005-0.0015, and with insertive vaginal intercourse is 0.0003-0.0009 per episode. Local inflammation, bleeding, or trauma can affect the risk of transmission also. 20 Victims should be counseled regarding HIV testing and the need for repeat testing. Besides the uncertainty of risk of exposure after sexual assault, other factors complicating decision making about PEP for HIV include potential inability to identify or test the assailant for HIV; expense of PEP (about $700); side effects of medication (nausea, vomiting, anorexia in up to 50 percent of patients); the need for laboratory testing; and the need to provide follow-up with physicians informed about PEP for HIV. No specific guidelines for PEP in cases of sexual assault are available as of this writing. Physicians who consider offering postexposure therapy with antiretroviral agents should consider the likelihood of exposure to HIV, the risks and benefits of such therapy, the interval between exposure and therapy, the local epidemiology of HIV/AIDS, the nature of the assault, and any high HIV-risk behaviors exhibited by the assailant. Victims should be informed of the risks and benefits of antiretroviral therapy. If a patient decides to take postexposure therapy, the guidelines for occupational mucous membrane exposure would be followed with treatment begun within 72 h.19 See Chap, 148 regarding occupational exposure guidelines.

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