Occupational exposure to HIV: Experience at a tertiary care center

We examined our hospital-based occupational health clinic's experience with combination antiretroviral therapy for postexposure prophylaxis for human immunodeficiency virus (HIV). Over a 12-month period, 68 workers started po stexposure prophylaxis: 23 with zidovudine and lamivudine and 45 with zidov udine, lamivudine, and indinavir. Fifty-one (75%) of the 68 workers startin g postexposure prophylaxis reported one or more side effects. Side effects were more common among those taking three drugs. Many workers failed to com plete the recommended 28-day regimen because of the side effects of the var ious treatments. The estimated mean cost for evaluations, prophylaxis, and monitoring of exposed workers was $669 per reported exposure. In our experi ence, major challenges in carrying out the current HIV postexposure prophyl axis guidelines include expeditious source testing, improved staff educatio n and prevention measures, and scrupulous monitoring of workers taking comb ination antiretroviral drugs for postexposure prophylaxis, with considerati on of alternate regimens for intolerant workers.