Reports on HIV/AIDS: 1990

JANUARY 26, 1990, MMWR, Vol. 39, RR-1: [inclusive page numbers]
Public Health Service
Statement on Management of
Occupational Exposure to
Human Immunodeficiency Virus,
Including Considerations Regarding
Zidovudine Postexposure Use
INTRODUCTION
CDC has issued guidelines to reduce the risk of human immunodeficiency virus
(HIV) infection among health-care workers, emergency-response and public-safety
workers, and others who might be exposed to HIV while performing job duties (1-4).
The safety practices outlined in these guidelines remain the primary means of
preventing occupational acquisition of HIV infection (5). Additionally, some physicians and some institutions have offered the option of using zidovudine (azidothymidine, AZT, ZDV, Retrovir) after occupational exposure to HIV (6). Data collected in an
ongoing CDC surveillance project of health-care workers who have been occupationally exposed to blood from HIV-infected patients (7) indicate that during the period
April-December 1989, 13 (8.6%) of 151 newly enrolled participants began a postexposure regimen of zidovudine.
This report reviews Public Health Service (PHS) recommendations for postexposure management of workers who have occupational exposures that may place them
at risk of acquiring HIV infection, provides background information on zidovudine and
experience with zidovudine postexposure prophylaxis, and presents considerations
relevant to a decision to offer postexposure prophylaxis.
Definition of Occupational Exposure
For purposes of this document, an occupational exposure (i.e., exposure that
occurs during the performance of job duties) that may place a worker at risk of HIV
infection is defined as a percutaneous injury (e.g., a needlestick or cut with a sharp
object), contact of mucous membranes, or contact of skin (especially when the
exposed skin is chapped, abraded, or afflicted with dermatitis or the contact is
prolonged or involving an extensive area) with blood, tissues, or other body fluids to
which universal precautions apply, including: a) semen, vaginal secretions, or other
body fluids contaminated with visible blood, because these substances have been
implicated in the transmission of HIV infection (2); b) cerebrospinal fluid, synovial
fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid, because the
risk of transmission of HIV from these fluids has not yet been determined (2); and
c) laboratory specimens that contain HIV (e.g., suspensions of concentrated virus).