10th Conference on Retroviruses and Opportunistic Infections Boston, MA USA - February 10 -14, 2003

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 42
A. Wulfsohn¹, W. D. F. Venter², D. Schultze³, M. Levey¹, I. M. Sanne^3 
1Johannesburg, South Africa; ²Reproductive Hlth Res Unit, Univ of the Witwatersrand, Johannesburg, South Africa; and ³Clin HIV Res Unit, Univ of the Witwatersrand, Johannesburg, South Africa

BACKGROUND: Gauteng Province in South Africa has an adult HIV seroprevalence of just below 30%. South Africa has a very high sexual assault incidence, particularly amongst young women and children. A private healthcare facility in Johannesburg began providing HIV post-exposure prophylaxis (PEP), using AZT and 3TC, as part of their package of care for sexual assault survivors in 1999.

METHODS: A retrospective record review of medical files describing demographics, the details of the assault, HIV status before and after PEP, and subsequent attendance.

RESULTS: Of 858 patients (pts) who were seen over a 3-year period, 14% were HIV-positive at presentation in the first year and 22% in the final year. Multiple assailants were involved in 65% of cases. A total 644 survivors received PEP within 72 hours; 500/644 returned after 6 wks and accepted testing; and 66% of pts returned for repeat HIV testing. A single HIV infection occurred in a 14-yr-old mentally-challenged woman, who did not complete the full 28 days of treatment and for whom repeated exposure was suspected. A 16-yr-old woman, who presented 12 days after an assault (and therefore did not receive PEP), was documented HIV ELISA negative and subsequently seroconverted. She had no risk factors for acquiring HIV other than the assault.

CONCLUSIONS: In this group, despite a high incidence of multiple-assailant assault and a high background prevalence of HIV, only a single seroconversion was documented in treated returning patients. A seroconversion in a pt who did not receive PEP implies that transmission via sexual assault is possible. The South African government has agreed to make HIV post-exposure prophylaxis broadly available in the country, with the first sites becoming operational in mid-2002.

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