ANTIVIRAL CHEMOPROPHYLAXIS AFTER OCCUPATIONAL EXPOSURE TO HUMAN-IMMUNODEFICIENCY-VIRUS - WHY, WHEN, WHERE, AND WHAT

PURPOSE: To update ophthalmologists on recent developments in the area of antiviral chemoprophylaxis after occupational exposure to human im munodeficiency virus (HIV). Background information is provided by whic h to make an informed decision about whether to initiate antiviral che moprophylaxis against HIV infection. METHODS: We discuss why HIV poste xposure prophylaxis should be considered; when prophylaxis should be i nitiated; where prophylaxis medications should be located in the opera ting or emergency room; and what medications might be used and the fac tors influencing their selection. Recent provisional recommendations b y the Unit ed States Centers for Disease Control and Prevention and th e International AIDS Society-USA are reviewed along with literature de aling with antiviral chemoprophylaxis against HIV infection. RESULTS: Recommendations are made for specific antiviral chemoprophylaxis after occupational exposure to HIV based on the Centers for Disease Control and Prevention and the International AIDS Society-USA provisional rec ommendations. Uncertain areas and the minor discrepancies in these two reports are discussed.CONCLUSIONS: Prevention of HIV transmission aft er accidental occupational exposure is possible. Combination therapy i s more effective than monotherapy in treating HIV infections. Zidovudi ne (AZT or ZDV) is effective in postexposure prophylaxis; the combinat ion of zidovudine and lamivudine (3TC) and indinavir (IDV) has greater antiretroviral activity than zidovudine alone does. The requirements for effective HIV postexposure prophylaxis may be somewhat different t han those for optimum HIV treatment in the chronically ill HIV-positiv e patient. Ophthalmologists should have an in depth knowledge of curre nt thinking regarding HIV pathophysiology and treatment.