TOLERABILITY, SAFETY, AND ACCEPTABILITY OF ZIDOVUDINE PROPHYLAXIS IN HEALTH-CARE WORKERS

Objective: To evaluate the safety, tolerability, and acceptability of zidovudine used for prevention of human immunodeficiency virus (HIV) t ransmission to health care workers. Methods: Prospective study between January 1989 and December 1992 at a suburban New York City medical ce nter of health care workers who had percutaneous or permucosal exposur es to blood or body fluids of HIV-infected patients. The zidovudine re gimen offered was 200 mg orally every 4 hours for 42 days. Results: On ly 60 (53%) of 113 health care workers chose to take zidovudine, and o nly 21 (35%) of these health care workers completed the recommended 42 -day course of therapy. Men were more likely than women to choose zido vudine therapy (P=.06), and a greater proportion of men completed the full 42 days of zidovudine therapy (P=.09). The most frequent reason f or stopping treatment prematurely was clinical adverse reactions (n=18 [30%]). Overall, clinical adverse events occurred in 44 (73%) of thos e taking zidovudine, with the most frequent events being nausea (n=28 [47%]), headache (n=21 [35%]), and fatigue (n=18 [30%]). Selected labo ratory parameters (hemoglobin level, hematocrit, alanine aminotransfer ase level, and white blood cell, granulocyte, and platelet counts) wer e compared at baseline and at week 4. Of interest, platelet counts wer e significantly more likely to increase by week 4 than to remain the s ame or decrease (P=.035). This observation may shed light on the mecha nism of platelet elevation seen in zidovudine-treated patients infecte d with HIV. None of the laboratory changes was considered cliniclly si gnificant. Of the 42 health care workers followed up for 3 months or l onger (range, 3 to 32 months), none had undergone HIV antibody serocon version. Conclusions: Zidovudine therapy is poorly accepted and tolera ted by health care workers, at least in the dosage regimen used in thi s study. Alternative prophylactic regimens are needed.