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Is Zidovudine a Prophylactic Treatment for Health Care Workers?-Reply

Is Zidovudine a Prophylactic Treatment for Health Care Workers?-Reply Abstract In reply We appreciate the comments of Coutellier and colleagues, who point out that despite zidovudine therapy, human immunodeficiency virus (HIV) may still be transmitted to an exposed health care worker. This has happened on at least eight occasions,1-3 including the case cited by Coutellier et al.3 Anecdotal accounts of failures following the use of zidovudine for postexposure prophylaxis are of great concern, but provide only limited information on the efficacy of this approach. Without more rigorously collected data, it is difficult to draw any firm conclusions regarding the efficacy of zidovudine prophylaxis or the risk-benefit ratio of this therapy. More compelling are the results of two recent studies. A US Public Health Service study compared health care workers since 1988 in whom seroconversion occurred after percutaneous exposure to HIV-infected blood with similarly exposed health care workers in whom HIV infection did not develop.4 The preliminary findings References 1. Gerberding JL. Management of occupational exposures to blood-borne viruses. N Engl J Med . 1995;332:444-451.Crossref 2. Tokars JL, Marcus R, Culver DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med . 1993;118:913-919.Crossref 3. Coutellier A, Desmoulins C, Veron M, Herson S. Failure of zidovudine prophylaxis after occupational needlestick injury. In: Program and abstracts of the Ninth International Conference on AIDS ; June 6-11, 1993; Berlin, Germany. Abstract B26-2074. 4. Cardo D, Srivastava P, Ciesielski C, et al. Case-control study of HIV seroconversion in health care workers after percutaneous exposure to HIV-infected blood. Presented at the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 4-7, 1994; Orlando, Fla. 5. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med . 1994;331:1173-1180.Crossref 6. Hirschel B, Kinloch S, Hoehn B, et al. Controlled trial of zidovudine in primary HIV infection. Presented at 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 4-7, 1994; Orlando, Fla. 7. Erice A, Mayers DL, Strike DG, et al. Brief report: primary infection with zidovudine-resistant human immunodeficiency virus type 1. N Engl J Med . 1993;328:1163-1165.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Is Zidovudine a Prophylactic Treatment for Health Care Workers?-Reply

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430160170019
Publisher site
See Article on Publisher Site

Abstract

Abstract In reply We appreciate the comments of Coutellier and colleagues, who point out that despite zidovudine therapy, human immunodeficiency virus (HIV) may still be transmitted to an exposed health care worker. This has happened on at least eight occasions,1-3 including the case cited by Coutellier et al.3 Anecdotal accounts of failures following the use of zidovudine for postexposure prophylaxis are of great concern, but provide only limited information on the efficacy of this approach. Without more rigorously collected data, it is difficult to draw any firm conclusions regarding the efficacy of zidovudine prophylaxis or the risk-benefit ratio of this therapy. More compelling are the results of two recent studies. A US Public Health Service study compared health care workers since 1988 in whom seroconversion occurred after percutaneous exposure to HIV-infected blood with similarly exposed health care workers in whom HIV infection did not develop.4 The preliminary findings References 1. Gerberding JL. Management of occupational exposures to blood-borne viruses. N Engl J Med . 1995;332:444-451.Crossref 2. Tokars JL, Marcus R, Culver DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med . 1993;118:913-919.Crossref 3. Coutellier A, Desmoulins C, Veron M, Herson S. Failure of zidovudine prophylaxis after occupational needlestick injury. In: Program and abstracts of the Ninth International Conference on AIDS ; June 6-11, 1993; Berlin, Germany. Abstract B26-2074. 4. Cardo D, Srivastava P, Ciesielski C, et al. Case-control study of HIV seroconversion in health care workers after percutaneous exposure to HIV-infected blood. Presented at the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 4-7, 1994; Orlando, Fla. 5. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med . 1994;331:1173-1180.Crossref 6. Hirschel B, Kinloch S, Hoehn B, et al. Controlled trial of zidovudine in primary HIV infection. Presented at 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 4-7, 1994; Orlando, Fla. 7. Erice A, Mayers DL, Strike DG, et al. Brief report: primary infection with zidovudine-resistant human immunodeficiency virus type 1. N Engl J Med . 1993;328:1163-1165.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 11, 1995

References