Children and adolescents are at risk for human immunodeficiency virus (HIV) infection. Transmission occurs through perinatal exposures, injecting drug use, consensual and nonconsensual sex, needle-stick and sharp injuries, and possibly some unusual contacts. Youth engaging in high-risk sexual activities are especially endangered. Half of the estimated worldwide 5.3 million new HIV infections occur in adolescents and young adults aged 15 to 24. Of 20?000 known new adult and adolescent cases in the United States, 25% involve 13- to 21-year-olds. More than 1.4 million children worldwide (aged 15 and younger) are believed to be infected, and 1640 new cases are diagnosed daily. Of the 432?000 people reported to be living with HIV or acquired immunodeficiency syndrome (AIDS) in the United States, 5575 are children under 13.HIV postexposure prophylaxis (PEP) is a form of secondary HIV prevention that may reduce the incidence of HIV infections. HIV PEP is commonly conceived of as 2 types: occupational and nonoccupational. Occupational HIV PEP is an accepted form of therapy for health care workers exposed to HIV through their jobs. A landmark study of healthcare workers concluded that occupational HIV PEP may be efficacious. Well-established US national guidelines for occupational HIV PEP exist for this at-risk population.Nonoccupational HIV PEP includes all other forms of HIV PEP, such as that given after sexual assault and consensual sex, injecting drug use, and needle-stick and sharp injuries in non-health care persons. Pediatric HIV PEP is typically the nonoccupational type. The efficacy of nonoccupational HIV PEP is unknown. The presumed efficacy is based on a collection of animal and human data concerning occupational, perinatal, and nonoccupational exposures to HIV. In contrast to occupational HIV PEP, there are no national US guidelines for nonoccupational HIV PEP, and few recommendations are available for its use for adolescents and children. Regardless of this absence, there is encouraging evidence supporting the value of HIV PEP in its various forms in pediatrics.Although unproven, the presumed mechanism for HIV PEP comes from animal and human work suggesting that shortly after an exposure to HIV, a window period exists during which the viral load is small enough to be controlled by the body's immune system. Antiretroviral medications given during this period may help to diminish or end viral replication, thereby reducing the viral inoculum to a more potentially manageable target for the host's defenses.HIV PEP is accepted practice in the perinatal setting and for health care workers with occupational injuries. The medical literature supports prescribing HIV PEP after community needle-stick and sharp injuries and after sexual assault from sources known or likely to be HIV-infected. HIV PEP after consensual unprotected intercourse between HIV sero-opposite partners has had growing use in the adult population, and can probably be utilized for children and adolescents. There is less documented experience and support for HIV PEP after consensual unprotected intercourse between partners of unknown HIV status, after prolonged or multiple episodes of sexual abuse from an assailant of unknown HIV status, after bites, and after the sharing of personal hygiene items or exposure to wounds of HIV-infected individuals.There are no formal guidelines for HIV PEP in adolescents and children. A few groups have commented on its provision in pediatrics, and some preliminary studies have been released. Our article provides a discussion of the data available on HIV transmission and HIV PEP in pediatrics.In our article, we propose an HIV PEP approach for adolescents and children. We recommend a stratified regimen, based on the work of Gerberding and Katz and other authors, that attempts to match seroconversion risk with an appropriate number of medications, while taking into account adverse side-effects and the amount of information that is typically available upon initial presentation. Twice daily regimens should be used when possible, and may improve compliance. HIV PEP should be administered within 1 hour of exposure. We strongly recommend that physicians trained in this form of therapy review the indications for HIV PEP within 72 hours of its provision. We advocate that due diligence in determining level of risk and appropriateness of drug selection be conducted as soon as possible after an exposure has occurred. When such information is not immediately available, we recommend the rapid treatment using the maximum level of care followed by careful investigation and reconsideration in follow-up or whenever possible. HIV PEP may be initiated provisionally after an exposure and then discontinued if the exposure source is confirmed to not be HIV-infected. In most cases, consultations with the experts in HIV care can occur after the rapid start of therapy. We also concur with other authors that HIV PEP be given in a therap
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机译：儿童和青少年有感染人类免疫缺陷病毒（HIV）的风险。传播是通过围产期暴露，注射毒品，自愿和非自愿的性行为，针刺和尖锐的伤害以及可能的一些异常接触而发生的。从事高风险性活动的青年尤其受到威胁。在估计的全球530万新的HIV感染中，有一半发生在15至24岁的青少年和年轻人中。在美国20万例已知的成人和青少年新病例中，有25％的人是13至21岁的年轻人。据信，全世界有超过140万儿童（15岁及以下）受到感染，每天诊断出的新病例超过1640例。在美国据报告的432 000 000患有艾滋病毒或获得性免疫缺陷综合症（AIDS）的人中，有5575名13岁以下的儿童。艾滋病毒暴露后预防（PEP）是艾滋病毒的二级预防形式，可以减少艾滋病毒的发生感染。 HIV PEP通常分为两种类型：职业性和非职业性。职业性艾滋病毒PEP是医护人员因工作而暴露于艾滋病毒的一种公认疗法。一项具有里程碑意义的医护人员研究得出结论，职业性HIV PEP可能有效。对于这一高危人群，已经建立了完善的美国职业性HIV PEP国家指南。非职业性HIV PEP包括所有其他形式的HIV PEP，例如性攻击和自愿性行为，注射毒品，针刺和尖锐注射后给予的形式。非医疗保健人员受伤。小儿HIV PEP通常是非职业性的。非职业性HIV PEP的疗效未知。假定的功效是基于动物和人类数据的收集，这些数据涉及职业性，围产期和非职业性HIV暴露。与职业性HIV PEP相比，美国没有针对非职业性HIV PEP的国家指南，很少有建议可用于青少年和儿童。不管是否存在这种情况，都有令人鼓舞的证据支持各种形式的HIV PEP在儿科中的价值。尽管未经证实，但推测的HIV PEP机制来自动物和人类的工作，这表明在暴露于HIV后不久，存在一个窗口期在此期间，病毒载量小到足以被人体的免疫系统控制。在此期间使用的抗逆转录病毒药物可能有助于减少或终止病毒复制，从而将病毒接种物降低到更容易控制的宿主宿主防御目标上。HIVPEP在围产期和职业伤害医疗保健工作者中被接受。医学文献支持在社区针刺和严重伤害后以及从已知或可能感染HIV的来源进行性侵犯后开具HIV PEP处方。 HIV血清对立伴侣之间自愿无保护的性交后的HIV PEP在成年人口中的使用越来越多，并且可能可用于儿童和青少年。在艾滋病毒状况不明的伴侣之间达成自愿无保护的性交之后，艾滋病毒状况不明的攻击者长时间或多次发作性虐待，被咬后以及共享个人卫生用品或暴露后，对艾滋病毒PEP的经验和支持的文献较少没有针对艾滋病毒感染者伤口的治疗方法。目前尚无针对青少年和儿童的HIV PEP正式指南。几个团体对儿科的规定发表了评论，一些初步研究已经发布。本文提供了有关儿科HIV传播和HIV PEP的可用数据的讨论。在本文中，我们提出了针对青少年和儿童的HIV PEP方法。我们建议根据Gerberding和Katz等人的工作制定分层方案，尝试将血清转化风险与适当数量的药物相匹配，同时考虑到不良副作用和初次使用时通常可获得的信息量介绍。如有可能，应每天使用两次养生法，并可能改善依从性。 HIV PEP应该在暴露后1小时内服用。我们强烈建议接受这种治疗形式培训的医生在提供HIV PEP的72小时内复查其适应症。我们主张在暴露发生后尽快进行尽职调查，以确定风险水平和药物选择的适当性。当无法立即获得此类信息时，我们建议使用最大程度的护理进行快速治疗，然后在随访中或可能的情况下进行仔细的调查和重新考虑。 HIV PEP可以在接触后临时启动，如果确定接触源未感染HIV，则可以中止。在大多数情况下，快速开始治疗后，可以与HIV护理专家进行磋商。我们还同意其他作者的意见，即在治疗中给予HIV PEP
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