Management of non-voluntary high-risk sexual exposures (HRSE)

MERCEDES CABRINI; FEDERICO MENSA; PAULA FRIED; ALICIA SISTO; NATALIA LAUFER; OSVALDO CANDO; HÉCTOR PÉREZ; PEDRO CAHN

Río de Janeiro, Brasil

Conferencia; 3rd IAS Conference on HIV Pathogenesis and Treatment; 2005

IAS

Introduction: To describe epidemiological characteristics of HRSE, evaluate postexposure prophylaxis (PEP), adverse events and follow-up.To describe epidemiological characteristics of HRSE, evaluate postexposure prophylaxis (PEP), adverse events and follow-up. Methods: We analyze 240 cases (200 adults and 40 cases < 16 years) of sexual exposure (SE) between 2002 and 2004. SE was defined as sexual intercourse following sexual assaults (SA) or accidental sexual exposure (ASE): discordant couples who referred broken condoms or unprotected intercourse.We analyze 240 cases (200 adults and 40 cases < 16 years) of sexual exposure (SE) between 2002 and 2004. SE was defined as sexual intercourse following sexual assaults (SA) or accidental sexual exposure (ASE): discordant couples who referred broken condoms or unprotected intercourse. Results: I) 200 adult patients with 201 SE episodes, 36.2% were ASE and 63.2% SA. Median age 26 (17-58), 154 female and 46 male. Median time to consultation: 24 hrs (1-1032). In the SA group 6 cases (6.6%) had known source, 1 was HIV+. Sexual partners in ASE were HIV+ in 42 cases, 1 seroconverted (0.0049%). Only 4 SA and none ASE completed 6 months follow-up. Procedures: 145 received the first dose of HBV vaccination, 130 prophylaxis for STD and 165 PEP: 25.4% received two ARV drugs (2AR) and 74.6% triple ARV-drug regimen (3AR). Thirty-four adverse events were reported in 29 patients (23 gastrointestinal, 4 back pain, 4 hyperbilirrubinemia and 1 leukopenia); without significant difference between 2DR or 3AR (p 0.176), 10% of those receiving Indinavir stopped due to adverse events. II) Thirty-nine cases of SA were in children, mean age: 14 years (8-16), 34 female and 5 male. Median time for consultation: 33 hrs (2-384). Thirty patients received PEP: 40% 2DR and 60%, 3DR. Adverse events: 3 patients (7.6%), 100% receiving 3AR. Twenty-eight children received STD prophylaxis, only 3 completed 6 months follow-up.I) 200 adult patients with 201 SE episodes, 36.2% were ASE and 63.2% SA. Median age 26 (17-58), 154 female and 46 male. Median time to consultation: 24 hrs (1-1032). In the SA group 6 cases (6.6%) had known source, 1 was HIV+. Sexual partners in ASE were HIV+ in 42 cases, 1 seroconverted (0.0049%). Only 4 SA and none ASE completed 6 months follow-up. Procedures: 145 received the first dose of HBV vaccination, 130 prophylaxis for STD and 165 PEP: 25.4% received two ARV drugs (2AR) and 74.6% triple ARV-drug regimen (3AR). Thirty-four adverse events were reported in 29 patients (23 gastrointestinal, 4 back pain, 4 hyperbilirrubinemia and 1 leukopenia); without significant difference between 2DR or 3AR (p 0.176), 10% of those receiving Indinavir stopped due to adverse events. II) Thirty-nine cases of SA were in children, mean age: 14 years (8-16), 34 female and 5 male. Median time for consultation: 33 hrs (2-384). Thirty patients received PEP: 40% 2DR and 60%, 3DR. Adverse events: 3 patients (7.6%), 100% receiving 3AR. Twenty-eight children received STD prophylaxis, only 3 completed 6 months follow-up. Conclusions: In our series patients requiring care for SE do so relatively short time after exposure. Providing PEP was not associated in this group with new exposures in the ASE group. One seroconversion occurred in a patient receiving 3AR (ASE group). We noticed poor compliance with follow-up, which prompt us to develop an active program to tackle this problem.In our series patients requiring care for SE do so relatively short time after exposure. Providing PEP was not associated in this group with new exposures in the ASE group. One seroconversion occurred in a patient receiving 3AR (ASE group). We noticed poor compliance with follow-up, which prompt us to develop an active program to tackle this problem.