Is Antiretroviral Treatment after Percutaneous HIV Exposure Justified?

The practice of treating health care providers occupationally exposed to human immunodeficiency virus with zidovudine has become widespread, despite the absence of data showing treatment efficacy. We need to encourage basic and clinical research relevant to occupational exposure so that a scientific basis for postexposure use can be established. In the interim, Provision of zidovudine or other antiviral agents should be regarded as an experimental treatment option, not as a standard of care.

At least 50 000 health care workers may have sustained needlestick or similar percutaneous exposures to human immunodeficiency virus (HIV) in the first decade of the acquired immunodeficiency syndrome (AIDS) epidemic. Primary prevention will reduce but not eliminate this problem. Clinicians caring for exposed workers face a difficult dilemma. Should zidovudine (AZT, Retrovir) therapy be given?

In this issue, Tokars and colleagues [1] describe eight health care workers who became infected with HIV despite zidovudine treatment after their percutaneous exposure [1]. Without a randomized trial or a longitudinal study to compare infection rates in zidovudine-treated patients and historical controls, it is not possible to determine whether the drug offers any protection because treatment successes cannot be documented. Some experts are advocating postexposure treatment with zalcitabine (dideoxycytidine, ddC, Hivid) or didanosine (dideoxyinosine, ddI, Videx) alone or in combination with zidovudine, especially when possible infection with zidovudine-resistant virus is suspected.

Few would argue the need for controlled clinical trials to evaluate the efficacy and toxicity associated with prophylactic therapy. However, given the widespread use of zidovudine among exposed health care workers and source patients, conducting a successful placebo-controlled efficacy study of this drug may no longer …