Single-tablet regimen of emtricitabine/tenofovir disoproxil fumarate plus cobicistat-boosted elvitegravir increase adherence for HIV postexposure prophylaxis in sexual assault victims

2020 ◽  
pp. sextrans-2020-054714
Author(s):  
Stefano Malinverni ◽  
Floriane Bédoret ◽  
Magali Bartiaux ◽  
Christine Gilles ◽  
Stéphane De Wit ◽  
...  
Keyword(s):  
Sexual Assault ◽  
Tenofovir Disoproxil Fumarate ◽  
Public Health Intervention ◽  
Clinic Visit ◽  
Postexposure Prophylaxis ◽  
Retrospective Case ◽  
Patient Demographics ◽  
Single Tablet Regimen ◽  
Assault Victims

BackgroundPostexposure prophylaxis (PEP) is a recommended public health intervention after a sexual assault to prevent HIV infection.MethodsWe conducted a retrospective case-control study on how use of a single-tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) affected adherence to PEP and attendance of a follow-up visit to the STI clinic compared with those who received a multitablet regimen (MTR). Data from sexual assault victims consulting for PEP were prospectively recorded between January 2011 and December 2017. Data were systematically collected on patient demographics, time of medical contact, source risk factors, type of exposure, attendance to follow-up visit, reported completion of PEP and adherence based on pharmacy records.ResultsA total of 422 patients received PEP following a sexual assault, of whom 52% had documented completion of a 28-day PEP regimen and 71% attended a follow-up clinic visit. Patients who received an elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF)-based STR had a similar likelihood of attending their first follow-up visit (OR: 0.97; 95% CI: 0.64 to 1.48, p=0.90) but were more likely to complete the PEP regimen (OR: 1.70; 95% CI: 1.16 to 2.50, p=0.007). After adjusting for confounders, those who were prescribed an STR regimen were more likely to complete the PEP regimen (OR: 1.66, 95% CI: 1.09 to 2.53, p=0.019) than those who were prescribed an MTR such as stavudine/lamivudine/lopinavir/ritonavir or zidovudine/lamivudine/indinavir/ritonavir.ConclusionsSexual assault victims who were prescribed an STR based on EVG/COBI/FTC/TDF were more likely to complete PEP than those who were prescribed an MTR.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

Follow-up of sexual assault victims

1998 ◽  
Vol 179 (2) ◽  
pp. 336-342 ◽  
Author(s):  
Melisa M. Holmes ◽  
Heidi S. Resnick ◽  
Dale Frampton
Keyword(s):  
Sexual Assault ◽  
Assault Victims

scholarly journals Outcome of bilateral adrenalectomy in congenital adrenal hyperplasia: one unit’s experience

2006 ◽  
Vol 154 (3) ◽  
pp. 405-408 ◽  
Author(s):  
Cara Megan Ogilvie ◽  
Gill Rumsby ◽  
Tom Kurzawinski ◽  
Gerard S Conway
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Symptom Control ◽  
Clinic Visit ◽  
Bilateral Adrenalectomy ◽  
Successful Outcome ◽  
Management Problem ◽  
Adrenal Hyperplasia ◽  
Retrospective Case ◽  
Case Note Review

Objective: The use of bilateral adrenalectomy in the management of congenital adrenal hyperplasia (CAH) is controversial. We set out to review the outcome of 5 cases of CAH who have undergone adrenalectomy in our unit. Design: A retrospective case note review and subject interview of the experience of adrenalectomy in the setting of a tertiary adult CAH clinic. Methods: Subjects who had undergone adrenalectomy were reviewed at a routine clinic visit with particular reference to clinical and biochemical outcomes after adrenalectomy. Results: Two subjects underwent surgery for the sole indication of desire for fertility with successful outcome and without subsequent adrenal crises. Three women suffered from the common clinical management problem of unsuppressible hyperandrogenism and worsening obesity. Whilst the outcome of improved appearance and weight loss was achieved in these subjects, all three experienced significant complications including pigmentation and acute episodes of adrenal insufficiency. Conclusion: We present a mean follow-up of 4.2 patient years and conclude that this procedure may be suitable for selected women with CAH. Outcomes for those pursuing fertility were positive; however, complications were noted in those women for whom the procedure was performed for symptom control. Accepting that the number of subjects is small, it is clear that more data are required before widely recommending this procedure.

Sexual assault victims' compliance with follow-up care at one sexual assault treatment center

1996 ◽  
Vol 22 (6) ◽  
pp. 560-565 ◽  
Author(s):  
Marlene Putz ◽  
Beverly K. Thomas ◽  
Kathleen V. Cowles
Keyword(s):  
Sexual Assault ◽  
Treatment Center ◽  
Follow Up Care ◽  
Assault Victims

66: Sexual Assault Victims: Who Gets Lost to Follow-up?

2008 ◽  
Vol 52 (4) ◽  
pp. S62
Author(s):  
Y.W. De Leon ◽  
A. Brown ◽  
A. Cederquist ◽  
J.S. Jones ◽  
L. Rossman
Keyword(s):  
Sexual Assault ◽  
Assault Victims ◽  
Lost To Follow Up

scholarly journals Packing density and long-term occlusion after transcatheter vessel embolization with soft, bare-platinum detachable coils

2020 ◽  
Vol 4 ◽  
pp. 2
Author(s):  
James Vogler IV ◽  
Mark Gemender ◽  
Dmitri Samoilov
Keyword(s):  
Packing Density ◽  
Hepatic Arterial Infusion ◽  
Case Review ◽  
Technical Success ◽  
Retrospective Case ◽  
Infusion Chemotherapy ◽  
Patient Demographics ◽  
Detachable Coils

Objective: The objective of this study was to examine packing density and long-term recanalization rates after embolization with soft, bare-platinum ruby coils in the gastroduodenal artery (GDA). Materials and Methods: Retrospective case review of patients with hepatic malignancy who underwent coil occlusion of the GDA for radioembolization or hepatic arterial infusion chemotherapy between November 2013 and July 2018. Data on patient demographics, GDA diameter, length of coil pack, and distance between GDA origin and most proximal coil were collected. Packing density was calculated as the ratio between the volume of inserted coils and the volume of the vessel area that were filled with coil. The primary outcome was the rate of GDA recanalization, determined by review of hepatic arteriograms at follow-up. Results: Long-term occlusion free of recanalization was observed in 97.8% (88/90) of patients over a median follow-up time of 13.4 ± 11.3 months. Median vessel packing density was 55% (interquartile range 41–71) and procedural technical success was achieved in 100% (90/90) of patients. Of the 90 patients (72 men; mean age 63.8 ± 7.5 years), mean GDA diameter was 4.0 ± 0.8 mm and the proximal coil distance from GDA origin was 8.6 ± 3.0 mm. Mean coil pack length was 21.2 ± 7.6 mm. Recanalization occurred in 2.2% (2/90) of patients. No increase in recanalization rates with distal coil placement was observed. Conclusions: The study demonstrates high levels of technical success and low rates of recanalization (2.2%) when high packing densities (55%) are achieved using soft, bare-platinum ruby coils. The rate of recanalization at follow-up compares favorably to previously reported literature.

scholarly journals HIV Postexposure Prophylaxis Use Among Ontario Female Adolescent Sexual Assault Victims: A Prospective Analysis

2008 ◽  
Vol 35 (12) ◽  
pp. 973-978 ◽  
Author(s):  
Janice Du Mont ◽  
Terri L. Myhr ◽  
Heather Husson ◽  
Sheila Macdonald ◽  
Anita Rachlis ◽  
...  
Keyword(s):  
Sexual Assault ◽  
Female Adolescent ◽  
Prospective Analysis ◽  
Postexposure Prophylaxis ◽  
Assault Victims

HIV post-exposure prophylaxis after sexual assault: the experience of a sexual assault service in London

2002 ◽  
Vol 13 (9) ◽  
pp. 602-605 ◽  
Author(s):  
S Limb ◽  
M Kawsar ◽  
G E Forster
Keyword(s):  
Sexual Assault ◽  
Adverse Events ◽  
Highly Active Antiretroviral Therapy ◽  
Post Exposure Prophylaxis ◽  
Retrospective Case ◽  
Post Exposure ◽  
Highly Active ◽  
Exposure Prophylaxis ◽  
Case Note Review

Objectives: To review the provision, uptake and outcome of HIV post-exposure prophylaxis (HIV-PEP) after sexual assault. Methods: A retrospective case note review of patients attending a sexual assault service in London during 1999. Results: Ten out of 150 patients were considered eligible for PEP after a careful risk assessment. Eight patients accepted HIV-PEP. Highly active antiretroviral therapy (HAART) consisted of Combivir/indinavir in six patients and Combivir/nelfinavir in two patients. Two patients changed their combination due to adverse events. Five patients completed the recommended 28 days of treatment. Three patients discontinued therapy due to adverse events. Two patients who completed HIV-PEP were noted to have raised cholesterol at follow-up. All patients who took PEP were HIV-1 and -2 antibody negative at six months. Conclusions: Compared with other published studies the completion rate of HIV-PEP in our study was high. The uptake and adverse events of HAART in this scenario were similar to previously published studies. A multidisciplinary approach to the management of this patient group will improve adherence to PEP.

The Progression of Human Papillomavirus Lesions in Sexual Assault Victims

PEDIATRICS ◽  
1995 ◽  
Vol 96 (6) ◽  
pp. 1163-1165
Author(s):  
Nancy D. Kellogg ◽  
Juan M. Parra
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
Sexual Assault ◽  
Condylomata Acuminata ◽  
Immunodeficiency Virus ◽  
Assault Victims ◽  
Term Management

Human papillomavirus (HPV) infections are seen in up to 15% of adolescents who present to a gynecology clinic.1 Anogenital HPV develops in some adolescents as a result of sexual assault. Sexual sault protocols address detection and follow-up for chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV) and hepatitis, 2,3 but follow-up for detection of HPV lesions is not formally addressed. Early detection of HPV lesions is important for treatment and long-term management, because subtypes 6, 10, 11, 16, 18, 31, 33, and 35 have been associated with cervical cancer.4 Although 6 and 11 are the most common subtypes found in condylomata acuminata, types 1, 2, 10, 16, and 18 are also found in anogenital lesions.5

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