The Journal of the Arkansas Medical Society Issue 6 Volume 115 | Page 14

SCIENTIFIC ARTICLE
HIV Post-exposure Prophylaxis
for Victims of Sexual Assault
Vini Vijayan, MD
Section of Infectious Diseases, Department of Pediatrics, UAMS, Little Rock, AR, 72202
ABSTRACT
Sexual assault of adolescents and
adults places these individuals at risk of
acquisition of sexually transmitted infec-
tions including HIV. The Centers for Disease
Control and Prevention provides recommen-
dations regarding HIV postexposure prophy-
laxis (PEP) following non-occupational expo-
sure to blood and body fluids.
Clinicians encountering victims of sexual
assault in their practice should be familiar
with the use of HIV PEP as prompt initiation
of PEP is associated with a reduced risk of
HIV seroconversion. We describe HIV risk
assessment and evaluation, management of
individuals exposed to potentially hazardous
body fluids through sexual contact, and
review recommended prophylactic regimens
for HIV.
INTRODUCTION
S
exual assault of adolescents and
adults often raises concern of
transmission of sexually trans-
mitted diseases (STIs), including human
immunodeficiency virus (HIV). 1 In a nation-
ally representative survey of adults, 2 nearly 1 in 5
(18.3%) women and 1 in 71 men (1.4%) reported
experiencing rape at some time in their lives. Of
these, 42.2% of female rape victims were first
raped before age 18, 29.9% of female rape victims
were first raped between the ages of 11-17 and
12.3% female rape victims and 27.8% of male rape
victims were first raped when they were age 10 or
younger. Sexual assault itself is often underreport-
ed and underestimated, and this makes the study
of HIV transmission after sexual assault difficult. 1,2
In 2016, the Centers for Disease Control and
Prevention published updated guidelines for use
of HIV postexposure prophylaxis (PEP) for persons
with nonoccupational exposure (e.g., sexual con-
tact; sharing of injection drug needles, or other
equipment) to blood and body fluids. The updated
guidelines incorporate the use of rapid antigen/
antibody (Ag/Ab) combination HIV tests, revised
preferred and alternative 3-drug antiretroviral
PEP regimens, an updated schedule of laboratory
evaluations of source and exposed persons as well
as updated antimicrobial regimens for prophylaxis
of sexually transmitted infections and hepatitis. 3,4 to recommend PEP, the clinician should assess and
carefully weigh the following factors:
This article aims to update clinicians regarding
current guidelines and recommendations for HIV
PEP following nonoccupational exposures to blood
and body fluids, thereby enabling them to make an
informed decision on when HIV PEP is indicated for
adolescent and adult victims of sexual assault. Risk of HIV Transmission Following
Different Types of Exposures
General Principles Regarding Initiation of
HIV Post-exposure Prophylaxis
Health care providers should rapidly evaluate
patients for PEP when care is sought ≤ 72 hours
after a potential exposure that presents a substan-
tial risk for HIV acquisition. When deciding whether
1. Patient’s risk of HIV acquisition based on the
type of exposure
2. Knowledge of the HIV status of the alleged as-
sailant
3. Amount of time that has elapsed after expo-
sure as PEP should be administered as soon as
possible and within 72 hours.
4. Whether the victim is ready and willing to com-
plete the 28-day PEP regimen
The frequency of HIV transmission is relatively
low, given that the risk of transmission in consen-
sual sex is 0.1% to 0.2% for vaginal and 0.5% to
3% for receptive anal intercourse. 5 Although most
perpetrators are not HIV positive, estimated risk
per act varies depending on the type of exposure
and cases of HIV transmission following sexual as-
sault have been described. It is also important to
consider that HIV prevalence in sexual assailants
may be higher than that in the general population.
Additionally, particular characteristics of the assault
Type of Exposure Risk per 10,000 exposures
Receptive Anal Intercourse 138
Insertive Anal Intercourse 11
Receptive Penile-vaginal Intercourse 8
Insertive Penile-vaginal Intercourse 4
Insertive and Receptive Oral Intercourse Low
Biting and Spitting Negligible
^
* Factors that may increase the risk of HIV transmission include sexually transmitted diseases, acute
and late-stage HIV infection, and high viral load. 
^
HIV transmission through these exposure routes is technically possible but unlikely and not well
documented.
Source: http://www.cdc.gov/hiv/policies/law/risk.html
134 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 115