Skip to main content
SpringerLink
Log in

Zidovudine prophylaxis for needlestick exposure to human immunodeficiency virus

A decision analysis

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Objective:To perform a decision analysis to determine the thresholds of safety and effectiveness that would fustify short-term zidovudine (AZT) administration for persons with accidental percutaneous exposure to HIV-positive blood.

Design:Published data were used to estimate the seroconversion rate (0.42%), rate of developing AIDS if HIV-infected (5%/year), and survival with AIDS (50%/year). No information is available on zidovudine effectiveness and little is known about fatal toxicity of zidovudine. Death from AIDS or from zidovudine toxicity was used as the endpoint.

Results:For those with exposure to blood known to be HIV-seropositive, the benefits of zidovudine outweigh the risks if efficacy is above approximately 3% to 8%. Wide variations in the assumptions have little effect on the thresholds.

Conclusions:Since clinical trials to determine zidovudine effectiveness in this setting will probably never be done, decision analysis offers the only quantitative method for addressing this question. Unless future studies show zidovudine to be both ineffective and toxic, the benefits of short-term administration of zidovudine outweigh the risks immediately after exposure to HIV-positive blood. Zidovudine benefits do not clearly outweigh the risks after exposure to blood of unknown serologic status, or if there is a delay in starting therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fischl MA, Richman DD, Grieco MH, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med. 1987;317:185–91.

    Article  PubMed  CAS  Google Scholar 

  2. Tavares L, Roneker C, Johnston K, Lehrman SN, de Noronha F. 3′-azido-3′-deoxythymidine in feline leukemia virus-infected cats: a model for therapy and prophylaxis of AIDS. Cancer Res. 1987;47:3190–4.

    PubMed  CAS  Google Scholar 

  3. Ruprecht RM, O’Brien LG, Rossoni LD, Nusinoff-Lehrman S. Suppression of mouse viraemia and retroviral disease by 3′-azido-3′-deoxythymidine. Nature. 1986;323:467–9.

    Article  PubMed  CAS  Google Scholar 

  4. Booth W. NIH offers AZT to exposed workers. Science. 1989;243:1137.

    PubMed  CAS  Google Scholar 

  5. Beck JR, Pauker SG. The Markov process in medical prognosis. Med Decis Making. 1983;3:419–58.

    Article  PubMed  CAS  Google Scholar 

  6. Marcus R, CDC Cooperative Needlestick Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988;319:1118–23.

    Article  PubMed  CAS  Google Scholar 

  7. Cooper GS, Jeffers DJ. The clinical prognosis of HIV-1 infection: a review of 32 follow-up studies. J Gen Intern Med. 1988;3:525–32.

    Article  PubMed  CAS  Google Scholar 

  8. Rothenberg R, Woelfel M, Stoneburner R, Milberg J, Parker R, Truman B. Survival with the acquired immunodeficiency syndrome: experience with 5,833 cases in New York City. N Engl J Med. 1987;317:1297–302.

    Article  PubMed  CAS  Google Scholar 

  9. National Center for Health Statistics. Vital statistics of the United States, 1985, Vol. II, Mortality, part A. DHHS publication no. (PHS) 88-1101. Public Health Service, Washington, DC: U.S. Government Printing Office, 1988.

  10. Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. N Engl J Med. 1987;317:192–7.

    Article  PubMed  CAS  Google Scholar 

  11. Gill PS, Rarick M, Brynes RK, Causey D, Loureiro C, Levine AM. Azidothymidine associated with bone marrow failure in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1987;107:502–5.

    PubMed  CAS  Google Scholar 

  12. Bloom DE, Glied S. The evolution of AIDS economic research. Health Policy. 1989;11:187–96.

    Article  PubMed  CAS  Google Scholar 

  13. Henderson DK, Gerberding JL. Prophylactic zidovudine after occupational exposure to the human immunodeficiency virus: an interim analysis. J Infect Dis. 1989;160:321–7.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinical Trials Unit, Mount Sinai Medical Center, Box 1042, 10029, New York, NY

    Henry S. Sacks PhD, MD

Authors
  1. Henry S. Sacks PhD, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David N. Rose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Received from the Clinical Trials Unit and the Departments of Medicine, Community Medicine, and Biomathematical Sciences, Mount Sinai School of Medicine of the City University of New York, New York, New York.

Supported in part by grant no. NOI-AI-72627 from the National Institute of Allergy and Infectious Diseases.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sacks, H.S., Rose, D.N. Zidovudine prophylaxis for needlestick exposure to human immunodeficiency virus. J Gen Intern Med 5, 132–137 (1990). https://doi.org/10.1007/BF02600514

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02600514

Key words

Search

Navigation