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1 May 1996 | Volume 124 Issue 9 | Page 855
We describe two nurses who developed severe rash and hepatoxicity while receiving zidovudine and zalcitabine for chemoprophylaxis of human immunodeficiency virus (HIV) infection.
A 57-year-old nurse was stuck in the palm with a needle that was visibly contaminated with the blood of a patient who had the acquired immunodeficiency syndrome (AIDS) and had been receiving long-term zidovudine treatment. Within 3 hours of the injury, the nurse began receiving zidovudine. Because of concerns about drug resistance, zalcitabine was added the following day. After 3 weeks of therapy, the nurse developed fever, nausea, vomiting, and pruritic rash over her arms, neck, and legs. Laboratory test results showed increased liver enzyme levels and lymphocytopenia.
A 55-year-old nurse sustained a needlestick injury to her hand after drawing blood from an HIV-positive patient who had been receiving long-term zidovudine treatment. Within 6 hours of the injury, the nurse began receiving zidovudine and zalcitabine. Three weeks later, the patient developed a rash over her chest, abdomen, back, and extremities, accompanied by low-grade fever, nausea, and headache. Results of laboratory studies showed lymphocytopenia and an acute elevation in liver enzyme levels. Plasma levels of zidovudine and zalcitabine were within the standard therapeutic ranges (Table 1). LETTER
Hepatotoxicity and Rash Associated with Zidovudine and Zalcitabine Chemoprophylaxis
TO THE EDITOR:
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In both cases, the rash cleared and the lymphocytopenia and hepatitis resolved after discontinuation of therapy with the drugs. Both nurses remained HIV negative after 6 months of follow-up.
A trial of combination and monotherapy with zidovudine and zalcitabine in patients with advanced AIDS showed a 6% to 8% incidence of hepatic toxicity [1]. In several case reports, hepatotoxicity has been related to the use of zidovudine for the treatment of HIV infection [2-4], as has a syndrome of zidovudine hypersensitivity with hepatitis [5]. To our knowledge, ours are the first reported cases of severe adverse reactions related to the use of combination therapy with zidovudine and zalcitabine for HIV prophylaxis in otherwise healthy persons. Clinicians considering combination therapy with these drugs for preventing HIV infection should carefully monitor patients for adverse events.
Author and Article Information
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References
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TopAuthor & Article InfoReferences |
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1. Fischl MA, Stanley K, Collier AC, Arduino JM, Stein DS, Feinberg JE, et al. Combination and monotherapy with zidovudine and zalcitabine in patients with advanced disease. Ann Intern Med. 1995; 122:24-32.
2. Gradon JD, Chapnick EK, Sepkowitz DV. Zidovudine-induced hepatitis. J Intern Med. 1992; 231:317-9.
3. Dubin G, Braffman MN. Zidovudine-induced hepatitis. Ann Intern Med. 1989; 110:85-6.
4. Shriner K, Goetz MB. Severe hepatotoxicity in a patient receiving both acetaminophen and zidovudine. Am J Med. 1992; 93:94-6.
5. Wassef M, Keiser P. Hypersensitivity to zidovudine: report of a case and review of the literature. Clin Infect Dis. 1995; 20:1387-9.
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