Prophylaxis with zidovudine (AZT) after exposure to human immunodeficiency virus: a brief discussion of the issues for emergency physicians.

Sound scientific information with which to determine the true efficacy of zidovudine for prophylaxis will probably not be available soon. Physicians should educate themselves thoroughly on the issues. It is highly recommended that thoughtful discussions of the issue of transmission of HIV from health personnel to patients as well as the key articles cited in this discussion be read. The details of a prophylaxis program, including laboratory evaluation, are provided in an article by Henderson and Gerberding and in greater detail in the article by Go et al. (Health care workers exposed to HIV can be enrolled in the Centers for Disease Control surveillance program by calling 404/639-1644. To enroll persons with large exposures to HIV in the zidovudine prophylaxis study, call 800/537-9978.) ED directors should work closely with local infectious disease specialists to determine if such a program is needed and how to implement it. Further details regarding the implementation of a prophylaxis program should be obtained from the literature and the Centers for Disease Control. All of the details of such a program should be worked out well in advance so that knowledgeable and immediate counseling can be provided to health care workers within one or two hours of exposure. Highly qualified individuals and institutions vary in their recommendations on prophylaxis, although most provide them. Zidovudine probably does not provide very effective protection, if it provides any. However, the medical, social, and economic consequences of HIV infection of health care workers are very real, and the serious irreversible adverse effects of zidovudine are very rare.(ABSTRACT TRUNCATED AT 250 WORDS)