Reports on HIV/AIDS: 1990

JANUARY 26, 1990, MMWR, Vol. 39, RR-1: [inclusive page numbers]
prophylaxis, and the PHS cannot make a recommendation for or against the use of
zidovudine for this purpose because of the limitations of current knowledge.
The duration of follow-up needed to detect evidence of HIV transmission or
delayed toxicity among workers who take zidovudine is presently unknown. Workers
taking zidovudine postexposure may require follow-up to detect HIV seroconversion
for a longer period than that recommended for workers who do not take zidovudine.
Regardless of the length of follow-up, mechanisms should be developed to permit
workers taking zidovudine to be contacted if future information indicates the need for
additional evaluation.
If a physician offers zidovudine as prophylaxis after an occupational exposure and
the exposed worker elects to take the drug, the physician or other appropriate
health-care provider should obtain written informed consent from the worker for this
use of this drug. The consent document should reflect the information presented in
the counseling session, as outlined above, emphasizing the need for follow-up
medical evaluations and for precautions to prevent the transmission of HIV infection
during the follow-up period, including refraining from blood, semen, or organ
donation, refraining from breast-feeding, and either abstaining from sexual intercourse or using latex condoms during sexual intercourse, as discussed below.
Considerations regarding sexual intercourse for exposed workers taking zidovudine include 1) the possible risk of teratogenesis associated with zidovudine use, and
2) the risk of transmission of HIV to a sexual partner. The risk of teratogenesis among
offspring of either men or women taking zidovudine is unknown. Therefore, men and
women of reproductive age who are receiving zidovudine should abstain from, or use
effective contraception during, sexual intercourse throughout the time zidovudine is
being taken. In addition, to prevent HIV transmission to sexual partners, all exposed
workers, including pregnant women, should abstain from, or use latex condoms
during, sexual intercourse throughout the follow-up period.
Research Needs
Further data are needed to determine risk factors for occupational exposure to HIV,
to evaluate measures for preventing these exposures, and to identify risk factors for
HIV transmission after occupational exposure. Appropriate animal models of HIV
infection are needed, and animal studies should be conducted under experimental
conditions that mimic the circumstances of occupational exposure affecting humans.
Studies involving humans should be conducted to determine whether postexposure
prophylaxis with zidovudine or other agents is effective, and, if effective, should
define the optimal time that postexposure prophylaxis should be initiated and the
optimal duration of prophylaxis. Studies should also assess the toxicity of candidate
prophylactic agents, establish the optimal dosage for healthy individuals and for
persons with preexisting hepatic or renal dysfunction, and define the duration of
follow-up needed to detect evidence of HIV infection in persons receiving prophylaxis. Strains of HIV isolated from treated workers should be monitored to detect
development of drug resistance.
Expanded Surveillance of Workers with Occupational Exposures to HIV
CDC has expanded its ongoing surveillance of workers with occupational exposures to HIV (7) to collect additional information on postexposure chemoprophylaxis.
No names or other personal identifiers of workers are collected.

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