Doctors should not automatically give HIV drugs to every child who may have been accidentally exposed to the virus, according to the American Academy of Pediatrics. Although quickly starting HIV treatment -- an approach called post-exposure prophylaxis -- may reduce the risk that the virus takes hold after a suspected exposure, doctors first need to consider whether the risk of infection is greater than the risks associated with taking the drugs, they said.

Dr. Peter L. Havens of the Medical College of Wisconsin said that the risk of HIV after accidentally sticking oneself with a needle used on an HIV-positive person is actually quite low -- around 3 in 1,000. "You only recommend post-exposure prophylaxis if you know that the person is infected with HIV and that there was a true high-risk exposure," Havens said. "So when you get right down to it, the number of times that this would be recommended in actual practice is really quite low." The drugs used to prevent HIV in potentially exposed people are expensive, and typically cause a host of side effects, including upset stomach, diarrhea, headache and fatigue, Havens said.

Havens and colleagues reviewed information about the risks of getting HIV from different accidental exposures, such as blood transfusions, unprotected sex and needle sharing. Certain types of accidental exposures tend to occur more commonly in children, such as when children prick themselves with a used needle, or when infants become exposed to the breast milk of an HIV-positive woman. Havens stressed that while the report cautions against automatic treatment after every possible accidental exposure in children, doctors should not hesitate to give medicine to children who they believe have a real risk of getting HIV, such as children who have been sexually abused by an HIV-infected person.

But in all cases, doctors should first determine the risk that each exposure will lead to infection, and the chance that the person the child is exposed to actually has HIV, Havens said. When a child finds a needle by accident, the HIV status of the user is not known; and the longer HIV is exposed to air, the less likely it is to cause infection, he said. "In many ways, this can help people be reassured that they don't need to give postexposure prophylaxis for many of the most common community exposures," Havens concluded.

The report, "Postexposure Prophylaxis in Children and Adolescents for Nonoccupational Exposure to Human Immunodeficiency Virus," was published in the journal Pediatrics (2003;111(6):1475-1489).

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