Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience.

OBJECTIVE: To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy. METHODS: A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages. RESULTS: A total of 867 medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from 10 to 77 years old, most of them self-declared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis. CONCLUSION: In the present cohort, the profile of victims of sexual violence was low-educated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.

OBJETIVO: Avaliar a assistência prestada às mulheres vítimas de violência sexual e seu acompanhamento após o evento traumático, caracterizando o perfil sociodemográfico, antecedentes ginecológicos e circunstâncias do evento, além de relatar a aceitação e os efeitos colaterais da profilaxia para infecções sexualmente transmissíveis (ISTs) e a ocorrência de gravidez resultante da violência sexual. MéTODOS: Estudo de coorte retrospectivo compreendendo o período entre 2007 e 2016. Foram incluídas todas as mulheres em acompanhamento médico e clínico após episódio de violência sexual. Foram excluídos registros de violência doméstica, vítimas do sexo masculino e crianças e adolescentes que relataram atividade sexual consensual. O estudo incluiu estatísticas descritivas, com frequências e percentuais. RESULTADOS: Foram revisados 867 prontuários e 444 casos de violência sexual foram incluídos. A faixa etária foi 10 a 77 anos; a maioria das vítimas se autodeclarou branca, com entre 4 e 8 anos de escolaridade, e negou ter um parceiro sexual fixo. A violência sexual ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A maioria foi atendida no serviço de referência em até 72 horas após a violência, possibilitando profilaxias preconizadas. Houve alta aceitação da terapia antirretroviral (TARV), embora metade das usuárias relatasse efeitos colaterais. A soroconversão para o vírus da imunodeficiência humana (HIV, na sigla em inglês) ou para o vírus da hepatite B (HBV, na sigla em inglês) não foi detectada entre as vítimas. CONCLUSãO: Nesta coorte, o perfil das vítimas de violência sexual foi de mulheres brancas, de baixa escolaridade, e jovens. O evento traumático ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A assistência nas primeiras 72 horas após a violência sexual permite que o serviço de saúde realize intervenções profiláticas contra ISTs e gravidez indesejada.

Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience / Assistência a vítimas de violência sexual em um serviço de referência: Uma experiência de 10 Anos

Abstract Objective To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy. Methods A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages. Results A total of 867medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from10 to 77 years old, most of them selfdeclared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis. Conclusion In the present cohort, the profile of victims of sexual violence was loweducated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.

Resumo Objetivo Avaliar a assistência prestada às mulheres vítimas de violência sexual e seu acompanhamento após o evento traumático, caracterizando o perfil sociodemográfico, antecedentes ginecológicos e circunstâncias do evento, além de relatar a aceitação e os efeitos colaterais da profilaxia para infecções sexualmente transmissíveis (ISTs) e a ocorrência de gravidez resultante da violência sexual. Métodos Estudo de coorte retrospectivo compreendendo o período entre 2007 e 2016. Foram incluídas todas as mulheres em acompanhamento médico e clínico após episódio de violência sexual. Foram excluídos registros de violência doméstica, vítimas do sexo masculino e crianças e adolescentes que relataram atividade sexual consensual. O estudo incluiu estatísticas descritivas, com frequências e percentuais. Resultados Foram revisados 867 prontuários e 444 casos de violência sexual foram incluídos. A faixa etária foi 10 a 77 anos; a maioria das vítimas se autodeclarou branca, com entre 4 e 8 anos de escolaridade, e negou ter um parceiro sexual fixo. A violência sexual ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A maioria foi atendida no serviço de referência em até 72 horas após a violência, possibilitando profilaxias preconizadas. Houve alta aceitação da terapia antirretroviral (TARV), embora metade das usuárias relatasse efeitos colaterais. A soroconversão para o vírus da imunodeficiência humana (HIV, na sigla em inglês) ou para o vírus da hepatite B (HBV, na sigla em inglês) não foi detectada entre as vítimas. Conclusão Nesta coorte, o perfil das vítimas de violência sexual foi de mulheres brancas, de baixa escolaridade, e jovens. O evento traumático ocorreu predominantemente à noite, em via pública, por um agressor desconhecido. A assistência nas primeiras 72 horas após a violência sexual permite que o serviço de saúde realize intervenções profiláticas contra ISTs e gravidez indesejada.

HIV-1 genetic diversity and resistance to antiretroviral drugs among pregnant women in Ribeirão Preto (SP), Brazil. Cross-sectional study.

BACKGROUND: Increasing genetic diversity of HIV-1 and emergence of drug-resistant mutations may reduce the efficacy of antiretroviral therapy and prophylaxis that are used to prevent mother-to-child transmission. The aim of this study was to assess the genetic diversity and prevalence of drug-resistant mutations among HIV-infected pregnant women. DESIGN AND SETTING: Cross-sectional study at an outpatient clinic for infectious diseases within gynecology and obstetrics. METHODS: This study evaluated the dynamics of HIV-1 subtypes and the prevalence of transmitted and acquired drug-resistant mutations among 38 HIV-infected pregnant women (20 previously exposed to antiretroviral therapy and 18 naive), in Ribeirão Preto (SP), Brazil, between 2010 and 2011. Genotyping was performed by means of molecular sequencing of the protease and reverse transcriptase regions of the HIV-1 pol gene. RESULTS: Subtype B was identified in 84.2% of the samples, recombinant forms between B and F in 7.9%, subtype F1 in 5.3% and the recombinant form K/F in 2.6%. No mutation associated with transmitted drug resistance was detected in the samples from the naive pregnant women, whereas mutations associated with acquired drug resistance were found in 35.0% of the pregnant women previously exposed to antiretroviral therapy. CONCLUSION: The results showed that subtype B predominated, while there was low prevalence of sequences with transmitted drug resistance.

HIV-1 genetic diversity and resistance to antiretroviral drugs among pregnant women in Ribeirão Preto (SP), Brazil. Cross-sectional study

ABSTRACT BACKGROUND: Increasing genetic diversity of HIV-1 and emergence of drug-resistant mutations may reduce the efficacy of antiretroviral therapy and prophylaxis that are used to prevent mother-to-child transmission. The aim of this study was to assess the genetic diversity and prevalence of drug-resistant mutations among HIV-infected pregnant women. DESIGN AND SETTING: Cross-sectional study at an outpatient clinic for infectious diseases within gynecology and obstetrics. METHODS: This study evaluated the dynamics of HIV-1 subtypes and the prevalence of transmitted and acquired drug-resistant mutations among 38 HIV-infected pregnant women (20 previously exposed to antiretroviral therapy and 18 naive), in Ribeirão Preto (SP), Brazil, between 2010 and 2011. Genotyping was performed by means of molecular sequencing of the protease and reverse transcriptase regions of the HIV-1 pol gene. RESULTS: Subtype B was identified in 84.2% of the samples, recombinant forms between B and F in 7.9%, subtype F1 in 5.3% and the recombinant form K/F in 2.6%. No mutation associated with transmitted drug resistance was detected in the samples from the naive pregnant women, whereas mutations associated with acquired drug resistance were found in 35.0% of the pregnant women previously exposed to antiretroviral therapy. CONCLUSION: The results showed that subtype B predominated, while there was low prevalence of sequences with transmitted drug resistance.

Effect of antiretroviral drugs on maternal CD4 lymphocyte counts, HIV-1 RNA levels, and anthropometric parameters of their neonates.

PURPOSE: To study the effect of antiretroviral drugs administered during pregnancy on CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women and on the anthropometric parameters of their neonates. METHODS: A prospective study was conducted on 57 pregnant women and their neonates divided into 3 groups: ZDV Group, HIV-infected mothers taking zidovudine (n=20); triple therapy (TT) Group, mothers taking zidovudine+lamivudine+nelfinavir (n=25), and Control Group, normal women (n=12). CD4 lymphocyte counts and HIV-1 RNA levels of pregnant women were analyzed during two periods of pregnancy. The perinatal prognosis took into account preterm rates, birth weight, intrauterine growth restriction, perinatal death, and vertical transmission of HIV-1. Data were analyzed statistically using the nonparametric chi-square, Mann-Whitney, Friedman, Kruskal-Wallis, and Wilcoxon matched pairs tests, with the level of significance set at P<.05. RESULTS: The major maternal demographic and anthropometric data were homogeneous for the various groups. HIV-1 viral burden, which was initially elevated, median of 14,370 copies/mL, was significantly reduced in the TT group, reaching 40 copies/mL. With respect to T-CD4+ lymphocyte counts, there was a significant recovery in Group TT at the end of pregnancy, this value being significantly different from that for the ZDV group (P=0052). There was no difference between groups regarding gestation length, Apgar scores, or neonatal anthropometric classification. There was no case of vertical HIV-1 transmission. CONCLUSIONS: The results obtained for the present series demonstrate the efficiency and suggest safety of the use of antiretroviral drugs during pregnancy as revealed by anthropometric parameters of the neonate.

Effect of antiretroviral drugs on maternal CD4 lymphocyte counts, HIV-1 RNA levels, and anthropometric parameters of their neonates

OBJETIVOS: Estudar o efeito das drogas anti-retrovirais sobre a quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV-1 e parâmetros antropométricos de seus neonatos. MÉTODOS: Estudo prospectivo avaliando 57 gestantes e seus neonatos em três grupos: Grupo AZT, gestantes portadoras do HIV utilizando zidovudina (n=20); Grupo TT, mães utilizando zidovudina+lamivudina+nelfinavir (n=25), e Grupo Controle, mulheres saudáveis (n=12). A quantificação dos linfócitos TCD4 e RNA do HIV-1 de gestantes portadoras do HIV foi analisada em dois períodos durante a gestação. O prognóstico perinatal levou em consideração as taxas de pré-termos, restrição de crescimento intra-útero, mortalidade perinatal e transmissão vertical do HIV-1. Os dados foram analisados utilizando-se testes não paramétricos de qui-quadrado, Mann-Whitney, Friedman, Kruskal-Wallys e Wilcoxon para amostras pareadas, considerando-se significativos valores associados a p<0,05. RESULTADOS: Observou-se homogeneidade entre os dados demográficos e antropométricos de realce. A carga viral, inicialmente elevada (14.370 cópias/ml), reduziu-se significativamente no grupo com tratamento tríplice , chegando a 40 cópias/ml. Quanto à contagem de linfócitos CD4, observou-se recuperação significativa nas pacientes do grupo TT, no final da gestação, sendo esse valor significativamente diferente em comparação ao grupo AZT (p = 0,0052). Não se observou diferença entre os grupos quanto à duração da gestação, aos índices de Apgar, e à classificação antropométrica neonatal. Não houve nenhum caso de transmissão vertical do HIV-1. CONCLUSÕES: Os resultados obtidos na presente casuística demonstram eficiência e sugerem segurança no uso de anti-retrovirais na gestação sobre parâmetros antropométricos dos neonatos.

Antiretroviral therapy during pregnancy and early neonatal life: consequences for HIV-exposed, uninfected children.

Women have emerged as the fastest growing human immunodeficiency virus (HIV) infected population worldwide, mainly because of the increasing occurrence of heterosexual transmission. Most infected women are of reproductive age and one of the greatest concerns for both women and their physicians is that more than 1,600 infants become infected with HIV each day. Almost all infections are a result of mother-to-child transmission of HIV. With the advent of combination antiretroviral therapies, transmission rates lower than 2% have been achieved in clinical studies. Antiretroviral compounds differ from most other new pharmaceutical agents in that they have become widely prescribed in pregnancy in the absence of proof of safety. We reviewed antiretroviral agents used in pregnant women infected with human immunodeficiency virus, mother-to-child transmission, and their consequences for infants.

Antiretroviral therapy during pregnancy and early neonatal life: consequences for HIV-exposed, uninfected children

Women have emerged as the fastest growing human immunodeficiency virus (HIV) infected population worldwide, mainly because of the increasing occurrence of heterosexual transmission. Most infected women are of reproductive age and one of the greatest concerns for both women and their physicians is that more than 1,600 infants become infected with HIV each day. Almost all infections are a result of mother-to-child transmission of HIV. With the advent of combination antiretroviral therapies, transmission rates lower than 2 percent have been achieved in clinical studies. Antiretroviral compounds differ from most other new pharmaceutical agents in that they have become widely prescribed in pregnancy in the absence of proof of safety. We reviewed antiretroviral agents used in pregnant women infected with human immunodeficiency virus, mother-to-child transmission, and their consequences for infants.