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Hepatotoxicity and Rash Associated with Zidovudine and Zalcitabine Chemoprophylaxis
- Keith Henry, MD;
- Edward P. Acosta, PharmD; and
- Elise Jochimsen, MD
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TO THE EDITOR:
We describe two nurses who developed severe rash and hepatoxicity while receiving zidovudine and zalcitabine for chemoprophylaxis of human immunodeficiency virus (HIV) infection.
A 57-year-old nurse was stuck in the palm with a needle that was visibly contaminated with the blood of a patient who had the acquired immunodeficiency syndrome (AIDS) and had been receiving long-term zidovudine treatment. Within 3 hours of the injury, the nurse began receiving zidovudine. Because of concerns about drug resistance, zalcitabine was added the following day. After 3 weeks of therapy, the nurse developed fever, nausea, vomiting, and pruritic rash over her arms, neck, and legs. Laboratory test results showed increased liver enzyme levels and lymphocytopenia.
A 55-year-old nurse sustained a needlestick injury to her hand after drawing blood from an HIV-positive patient who had been receiving long-term zidovudine treatment. Within 6 hours of the injury, the nurse began receiving zidovudine and zalcitabine. Three weeks later, the patient developed a rash over her chest, abdomen, back, and extremities, accompanied by low-grade fever, nausea, and headache. Results of laboratory studies showed lymphocytopenia and an acute elevation in liver enzyme levels. Plasma levels of zidovudine and zalcitabine were within the standard therapeutic ranges (Table 1).
In both cases, the rash cleared and the lymphocytopenia and hepatitis resolved after discontinuation of therapy with the drugs. Both nurses remained HIV negative after 6 months of follow-up.
A trial of combination and monotherapy with zidovudine and zalcitabine in patients with advanced AIDS showed a 6% to 8% incidence of hepatic toxicity [1]. In several case reports, hepatotoxicity has been related to the use of zidovudine for the treatment of HIV infection [2-4], as has a syndrome of zidovudine hypersensitivity with hepatitis [5]. To our knowledge, ours are the first reported cases of severe adverse reactions related to the use of combination therapy with zidovudine and zalcitabine for HIV prophylaxis in otherwise healthy persons. Clinicians considering combination therapy with these drugs for preventing HIV infection should carefully monitor patients for adverse events.
Edward P. Acosta, PharmD
Elise Jochimsen, MD
University of Minnesota
Minneapolis, MN 55455
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
