Synopsis for January 5, 2001

MMWR articles are embargoed until 4 p.m. E.S.T. Thursdays.

1. Serious Adverse Events Attributed to Nevirapine Regimens for Postexposure Prophylaxis After HIV Exposure - Worldwide, 1997-2000.
2. Nonsocomial Poisoning Associated with Emergency Department Treatment of Organophosphate Toxicity - Georgia, 2000

Serious Adverse Events Attributed to Nevirapine Regimens for Postexposure Prophylaxis After HIV Exposure - Worldwide, 1997-2000.

To ensure that HIV-infected people receive appropriate screening and treatment for TB infection, it is critical to determine the HIV status of patients who are in prolonged, frequent, or intense contact with people with active TB disease.

In September, 2000, CDC received two reports of life-threatening hepatotoxicity (liver damage) among health care workers taking nevirapine for post-exposure prophylaxis (PEP) after occupational exposure to HIV.

This report suggests that persons taking NIP regimens for PEP after HIV exposure also are at risk for serious and adverse events. Nevirapine has not been recommended for PEP use and has previously been associated with instances of serious skin conditions, liver damage, and death when used for treating HIV-infected individuals. The recent reports prompted a review of FDA's registry of serious adverse events, which identified 20 other reports of serious side effects among people who had taken nevirapine for PEP. These 22 cases, in healthy, uninfected individuals who took the drug for a relatively short period of time (2 weeks, on average, before onset of symptoms) are cause for serious concern. Anyone considering PEP should consult with their physician to carefully weigh the risks of HIV infection related to their exposure, the potential benefits of post-exposure therapy, and the possible side effects of any PEP regimen. Recommended regimens are outlined in "Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis" (MMWR, Vol. 47, RR-7, May 15,1998; available online at www.cdc.gov/hiv/topics/treatment/index.htm.) In most circumstances, the risks associated with nevirapine as part of an occupational PEP regimen might outweigh the anticipated benefits.

Nonsocomial Poisoning Associated with Emergency Department Treatment of Organophosphate Toxicity - Georgia, 2000

Nosocomial Poisoning Associated with Emergency Department Treatment of Organophosphate Toxicity - Georgia, 2000

Health care workers require adequate protection to prevent contamination from chemically contaminated patients.

Emergency departments (ED) staff caring for patients contaminated with ingested organophosphate insecticides are at risk for developing organophosphate toxicity. This report describes three cases of occupational illnesses associated with organophosphate toxicity caused by exposure to a contaminated patient and underscores the importance of using personal protection equipment (PPE) and establishing and following decontamination procedures in Eds and other areas of acute care hospitals.

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