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Antiretroviral Prophylaxis: A Digestive Complication to Know
Anaïs Lemoine1, Joëlle Michot2, Jérôme Viala3
1From the Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital (APHP), Sorbonne Université, Paris, France.
Pediatric Emergency Care
|March 3, 2020
Summary
A child developed severe gastrointestinal bleeding (melena) from intestinal ulcers during antiretroviral prophylaxis after a needlestick injury. This case questions the safety of current antiretroviral guidelines for children, highlighting potential severe adverse effects.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Antiretroviral therapy is crucial for preventing infections after potential exposure.
- Standard prophylactic regimens often include lamivudine and zidovudine.
- Adverse effects of antiretrovirals can range from mild to severe.
Observation:
- An 8-year-old child presented with abdominal pain and melena.
- The child was undergoing antiretroviral prophylactic treatment following a needlestick injury.
- Endoscopic examination revealed duodenal and ileal ulcerations.
Findings:
- The severe adverse event of intestinal ulceration and melena occurred during prophylactic antiretroviral treatment.
- Lamivudine and zidovudine were part of the prophylactic regimen.
- The severity of the observed adverse effects was notable.
Implications:
- This case raises concerns about the safety and established guidelines for antiretroviral prophylaxis in children.
- Further investigation into the risk-benefit profile of specific antiretroviral agents in pediatric prophylaxis is warranted.
- Clinical practice may need re-evaluation regarding monitoring for severe gastrointestinal complications.
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