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July 10, 1996, Vol 276, No. 2 >
ARTICLE | July 10, 1996

Update: Provisional Public Health Service Recommendations for Chemoprophylaxis After Occupational Exposure to HIV FREE

JAMA. 1996;276(2):90-92. doi:10.1001/jama.1996.03540020012007
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References

ALTHOUGH preventing blood exposures is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection, appropriate post-exposure management is an important element of workplace safety.1 Information suggesting that zidovudine (ZDV) postexposure prophylaxis (PEP) may reduce the risk for HIV transmission after occupational exposure to HIV-infected blood2 prompted a Public Health Service (PHS) interagency working group,* with expert consultation,† to update a previous PHS statement on management of occupational exposure to HIV with the following findings and recommendations on PEP.‡1

Background  Although failures of ZDV PEP have occurred,3 ZDV PEP was associated with a decrease of approximately 79% in the risk for HIV seroconversion after percutaneous exposure to HIV-infected blood in a case-control study among health-care workers.2 In a prospective trial in which ZDV was administered to HIV-infected pregnant women and their infants, a direct effect of ZDV prophylaxis on the

REFERENCES

1 +
CDC.  Public Health Service statement on management of occupational exposure to human immunodeficiency virus, including considerations regarding zidovudine postexposure use . MMWR 1990;;39(no. (RR-1) ).
2 +
CDC.  Case-control study of HIV seroconversion in health-care workers after percutaneous exposure to HIV-infected blood—France, United Kingdom, and United States, January 1988-August 1994 . MMWR 1995;;44:929-33.
3 +
Tokars JI, 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;;118:913-9.
4 +
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;;331:1173-80.
5 +
Sperling RS, Shapiro DE, Coombs R, et al.  Maternal plasma HIV-1 RNA and the success of zidovudine in the prevention of mother-child transmission  [Abstract no. LB1]. In: Program and abstracts of the 3rd conference on retroviruses and opportunistic infections . Alexandria, Virginia: Infectious Diseases Society of America, 1996;.
6 +
Niu MT, Stein DS, Schnittmann SM.  Primary human immunodeficiency virus type 1 infection: review of pathogenesis and early treatment interventions in humans and animal retrovirus infections . J Infect Dis 1993;;168:1490-501.
7 +
Gerberding JL.  Management of occupational exposures to blood-borne viruses . N Engl J Med 1995;;332:444-51.
8 +
Anonymous.  New drugs for HIV infection . The Medical Letter on Drugs and Therapeutics 1996;;38:35-7.
9 +
Connor E, Sperling R, Shapiro D, et al.  Long term effect of zidovudine exposure among uninfected infants born to HIV-infected mothers in pediatric AIDS Clinical Trials Group protocol 076 . In: Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1995;;205.
10 +
Kinloch-de Loks S, Hirschel BJ, Hoen B, et al.  A controlled trial of zidovudine in primary human immunodeficiency virus infection . N Engl J Med 1995;;333: 408-13.
11 +
The interagency working group comprised representatives of CDC, the Food and Drug Administration (FDA), the Health Resources and Services Administration, and the National Institutes of Health. Information included in these recommendations may not represent FDA approval or approved labeling for the particular products or indications in question. Specifically, the terms "safe" and "effective" may not be synonymous with the FDA-defined legal standards for product approval.
12 +
CDC and the National Foundation for Infectious Diseases cosponsored a workshop, HIV Post-Exposure Management for Health Care Workers, on March 4-5, 1996; proceedings of the workshop will be published in the American Journal of Medicine.
13 +
Single copies of this report will be available free until June 7,1997, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or (301) 217-0023.
14 +
An HIV strain is more likely to be resistant to a specific antiretroviral agent if it is derived from a patient who has been exposed to the agent for a prolonged period of time (e.g., 6-12 months or longer). In general, resistance develops more readily in persons with more advanced HIV infection (e.g., CD4+ T-lymphocyte count of <200 cells/mm3), reflecting the increasing rate of viral replication during later stages of the illness.

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1 +
CDC.  Public Health Service statement on management of occupational exposure to human immunodeficiency virus, including considerations regarding zidovudine postexposure use . MMWR 1990;;39(no. (RR-1) ).
2 +
CDC.  Case-control study of HIV seroconversion in health-care workers after percutaneous exposure to HIV-infected blood—France, United Kingdom, and United States, January 1988-August 1994 . MMWR 1995;;44:929-33.
3 +
Tokars JI, 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;;118:913-9.
4 +
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;;331:1173-80.
5 +
Sperling RS, Shapiro DE, Coombs R, et al.  Maternal plasma HIV-1 RNA and the success of zidovudine in the prevention of mother-child transmission  [Abstract no. LB1]. In: Program and abstracts of the 3rd conference on retroviruses and opportunistic infections . Alexandria, Virginia: Infectious Diseases Society of America, 1996;.
6 +
Niu MT, Stein DS, Schnittmann SM.  Primary human immunodeficiency virus type 1 infection: review of pathogenesis and early treatment interventions in humans and animal retrovirus infections . J Infect Dis 1993;;168:1490-501.
7 +
Gerberding JL.  Management of occupational exposures to blood-borne viruses . N Engl J Med 1995;;332:444-51.
8 +
Anonymous.  New drugs for HIV infection . The Medical Letter on Drugs and Therapeutics 1996;;38:35-7.
9 +
Connor E, Sperling R, Shapiro D, et al.  Long term effect of zidovudine exposure among uninfected infants born to HIV-infected mothers in pediatric AIDS Clinical Trials Group protocol 076 . In: Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1995;;205.
10 +
Kinloch-de Loks S, Hirschel BJ, Hoen B, et al.  A controlled trial of zidovudine in primary human immunodeficiency virus infection . N Engl J Med 1995;;333: 408-13.
11 +
The interagency working group comprised representatives of CDC, the Food and Drug Administration (FDA), the Health Resources and Services Administration, and the National Institutes of Health. Information included in these recommendations may not represent FDA approval or approved labeling for the particular products or indications in question. Specifically, the terms "safe" and "effective" may not be synonymous with the FDA-defined legal standards for product approval.
12 +
CDC and the National Foundation for Infectious Diseases cosponsored a workshop, HIV Post-Exposure Management for Health Care Workers, on March 4-5, 1996; proceedings of the workshop will be published in the American Journal of Medicine.
13 +
Single copies of this report will be available free until June 7,1997, from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231 or (301) 217-0023.
14 +
An HIV strain is more likely to be resistant to a specific antiretroviral agent if it is derived from a patient who has been exposed to the agent for a prolonged period of time (e.g., 6-12 months or longer). In general, resistance develops more readily in persons with more advanced HIV infection (e.g., CD4+ T-lymphocyte count of <200 cells/mm3), reflecting the increasing rate of viral replication during later stages of the illness.

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