OBJECTIVE:To evaluate the safety, tolerability, and acceptability of zidovudine used for prevention of human immunodeficiency virus (HIV) transmission to health care workers. METHODS:Prospective study between January 1989 and December 1992 at a suburban New York City medical center of health care workers who had percutaneous or permucosal exposures to blood or body fluids of HIV-infected patients. The zidovudine regimen offered was 200 mg orally every 4 hours for 42 days. RESULTS:Only 60 (53%) of 113 health care workers chose to take zidovudine, and only 21 (35%) of these health care workers completed the recommended 42-day course of therapy. Men were more likely than women to choose zidovudine therapy (P = .06), and a greater proportion of men completed the full 42 days of zidovudine therapy (P = .09). The most frequent reason for stopping treatment prematurely was clinical adverse reactions (n = 18 [30%]). Overall, clinical adverse events occurred in 44 (73%) of those taking zidovudine, with the most frequent events being nausea (n = 28 [47%]), headache (n = 21 [35%]), and fatigue (n = 18 [30%]). Selected laboratory parameters (hemoglobin level, hematocrit, alanine aminotransferase level, and white blood cell, granulocyte, and platelet counts) were compared at baseline and at week 4. Of interest, platelet counts were significantly more likely to increase by week 4 than to remain the same or decrease (P = .035). This observation may shed light on the mechanism of platelet elevation seen in zidovudine-treated patients infected with HIV. None of the laboratory changes was considered clinically significant. Of the 42 health care workers followed up for 3 months or longer (range, 3 to 32 months), none had undergone HIV antibody seroconversion. CONCLUSIONS:Zidovudine therapy is poorly accepted and tolerated by health care workers, at least in the dosage regimen used in this study. Alternative prophylactic regimens are needed.

Many patients with human immunodeficiency virus (HIV) infection have also been infected with hepatitis C virus (HCV). To understand better the epidemiology of HCV infection in the health care setting, HCV antibody testing was done for 125 health care workers who had experienced parenteral exposures to blood of HIV-infected patients and for 33 control health care workers without such exposures. Of the 158 health care workers studied, two (1.3%) had positive tests for HCV, both on the baseline serum sample obtained at parenteral exposure. For the 98 exposed, seronegative health care workers who were prospectively followed, no HCV seroconversions were observed over a time of 17.6 +/- 16.9 months. At least 64 of these 98 health care workers were exposed to blood of HIV-infected intravenous drug users, a group with an HCV seroprevalence rate in excess of 50% at our center in suburban New York City. We conclude that parenteral exposure to blood of HIV-infected patients in the health care setting is rarely associated with the development of hepatitis C infection.

To the Editor.— Abnormal liver function test results are common in patients infected with the human immunodeficiency virus (HIV), and, although they are likely to be multifactorial in origin, they are undoubtedly related to viral hepatitis in some of these patients. The recent discovery of a serological marker for the hepatitis C virus has greatly improved diagnostic accuracy for this form of hepatitis.1Hepatitis C virus infection may be an important cause of significant liver disease in certain HIV-infected patients and poses an additional concern for health care personnel with occupational exposure to blood. In European studies, hepatitis C coinfection rates in excess of 50% have been found for both HIV-infected hemophiliacs and intravenous drug users, with rates as high as 26% reported for HIV-infected homosexual men.2,3 Few data are available, however, on hepatitis C coinfection rates for HIV-infected patients in the United States. The results of hepatitis

This study was carried out in two phases during the fall of 1987. In the first phase 102 tourniquets were collected at random from house officers, ward medication carts, intensive care units, the hemodialysis unit, and the phlebotomy and intravenous team carts. We estimate that tourniquets collected represented a substantial proportion (~50%) of those in use at the medical center at the time. Personnel were not informed as to the reason for the collection. Tourniquets with stains suggestive of blood were tested by the leucomalachite method.5 This catalytic test, which is widely used in forensic laboratories, is capable of detecting blood at a dilution of at least 1: 20,000.’ As controls new tourniquets were coded and stained with either povidone-iodine (No. lo), blood (No. lo), or ink (No. 4). In the second phase an anonymous questionnaire on tourniquet practices was distributed to the medical, surgical, pediatric, neurology, and anesthesiology residents, the intravenous and phlebotomy teams, and the nurses in the hemodialysis unit.

Certain attitudes of healthcare workers toward patients infected with human immunodeficiency virus are inconsistent with medical knowledge and appear unlikely to be changed significantly or quickly by standard educational methods. Such attitudes may be detrimental to the doctor-patient relationship. Also, they detract from the true message that healthcare professionals should be sending to the public: that acquired immunodeficiency syndrome is not spread by casual exposure, such as through food, water, or handling of food by infected persons.

Documented HIV seroconversion in health care workers from patient contact has occurred. The risk of HIV seroconversion from a single needle-stick accident from an infected patient has been shown to be about 0.35% on the basis of composite analysis of 8 seroprevalence studies. Needle-stick injury is the most important risk for health care workers occurring quite commonly. The frequency of injuries in workers caring for HIV infected patients in our hospital has declined from 4.6 needle-sticks/1000 HIV infected patient-days in 1984 to 1.9/1000 days from 1/1/86 to 6/30/87. The probability of nosocomial transmission of HIV in our institution can be calculated. 105000 HIV infected patient-days would yield a 50% chance of at least 1 case of HIV transmission to a health care worker. This number of patient days will be exceeded in many large urban medical centers over the next 4 years. Many institutions are likely to have to face the prospect of nosocomial transmission to a member of their staff in the next few years. Prevention of needle-stick injuries is a critical factor in avoiding this outcome.

Infection with human T-cell lymphotropic virus III (HTLV-III) is closely linked to the acquired immunodeficiency syndrome (AIDS). We evaluated the risk of nosocomial infection with HTLV-III by testing for antibodies to HTLV-III among hospital employees, including victims of needle-stick exposure, endoscopists, pathologists, and laboratory workers. Assays for antibody against the virus were performed by enzyme-linked immunosorbent assay and electrophoretic (Western blot) techniques. Although all 22 of our patients with AIDS and 6 of 7 with AIDS-related complex were found to have antibodies to HTLV-III when both assays were employed, none of the 85 employees with nosocomial exposure to specimens from patients with AIDS were positive for HTLV-III antibody. These studies must be regarded as preliminary, but they suggest that when current hospital isolation procedures are employed, the risk of nosocomial transmission of HTLV-III is low.