Children
All minors presenting following a potential risk of HIV exposure should be immediately considered for PEP. In the case of sexual assault, evaluation and treatment should be managed by a multidisciplinary team that is experienced in addressing the medical, psychosocial, and legal issues of such an offence. Parents or legal guardians should be notified unless the adolescent is ≥15 years and deemed legally competent to request that their guardians are not notified. Children who are sexually assaulted should be assessed for the risk of acquiring other STIs and the possibility of pregnancy for girls post-menarche. Emergency contraception should always be offered. The clinician should discuss key issues about PEP with the family and child as soon as possible. When parental or legal guardian consent cannot be obtained to initiate PEP, treatment may be initiated, with consent strongly recommended to continue PEP beyond the first hours/days. If PEP is prescribed, ensure sufficient medication is supplied to complete a full 28-day course.
Recommended dosage*:
| Weight 35kg or more |
|---|
| Preferred option: Tenofovir + Emtricitabine PLUS Raltegravir Secondary options: 1) Zidovudine + Lamivudine PLUS Raltegravir; 2) Zidovudine + Lamivudine PLUS Lopinavir + Ritonavir |
| Formulations |
| Tenofovir disoproxil fumarate 300mg + Emtricitabine 200mg (ONE co-formulated tab once daily) Do not use in renal impairment |
| Raltegravir 400mg tablet (ONE tab BD) |
| Tab: Zidovudine 300mg + Lamivudine 150mg (ONE co-formulated tab BD) |
| Tab: Adult Lopinavir 200mg + Ritonavir 50mg (TWO co-formulated tabs BD) Note strength of tablet |
| Weight under 35kg | |
|---|---|
Preferred option: Zidovudine + Lamivudine PLUS Lopinavir + Ritonavir ≥3 years Preferred option: Zidovudine + Lamivudine PLUS Raltegravir (if chewable available) Secondary option: Zidovudine + Lamivudine PLUS Lopinavir + Ritonavir |
|
| Formulations | |
| Zidovudine Cap 100mg or 250mg (180mg/m2/dose BD) OR Liquid: 10mg/ml (Max: 250mg BD) |
|
| Lamivudine Tab: 100mg or 150mg (4mg/kg/dose BD) OR Liquid: 10mg/ml (Max: 150mg BD) |
|
| Liquid: Lopinavir 80mg/ml + Ritonavir 20mg/ml (Co-formulated 300mg/m2/dose BD) (Max: 400mg BD Dose based on Lopinavir) OR |
|
|
Tab: Paediatric Lopinavir 100mg + |
Weight banded dosing using 100/25mg tablets: 15–25kg: TWO tablets BD 25–35kg: THREE tablets BD > 35kg: FOUR tablets BD |
| Raltegravir 25mg or 100mg CHEWABLE tablets These tablets are NOT bioequivalent to the 400mg Raltegravir tablet |
CHEWABLE tablet: 11–14kg 75mg BD 14–20kg 100mg BD 20–28kg 150mg BD 28–40kg 200mg BD > 40kg 300mg BD If >25kg and can swallow tablets: 400mg tablet BD |
*Determined in consultation with ANZPID Guidelines for post-exposure prophylaxis (PEP) after non-occupational exposure to blood borne viruses in children (2016).