As of May 1998, the Center for Disease Control and Prevention is recommending multiple drug postexposure prophylaxis for HJV, including zidovudine (AZT) plus lamivudine with or without a protease inhibitor (efavirenz), for healthcare workers who sustain a blood/body fluid exposure which is considered at increased or high risk for the transmission of l-IIV.


Combivir

Combivir is a combination antiviral medication with zidovudine (AZT) and lamivudine which is used to treat HJV-infected patients. In a case-control study completed in 1994 involving healthcare workers exposed to HI V-infected blood, zidovudine prophylaxis alone was associated with a decrease of approximately 79% in the risk for HIV transmission. Zidovudine has been shown to decrease transmission of HIV from mother to fetus. Animal studies also show that zidovudine prophylaxis may prevent HIV infection. Zidovudine and lamivudine combined have greater activity against HJV in patients compared with zidovudine alone.


Toxicity/Adverse Effects

The most common side effects include nausea, vomiting, abdominal pain, loss of appetite, stomach upset, diarrhea, headache and fatigue. Additional adverse reactions include dizziness, muscle pain or inflammation, joint pain, nervous system inflammation (numbness, seizures) or neuropathy, rash, cough, insomnia, nervousness, depression, fever, chills, liver inflammation, low red and white blood cell counts, low platelets which may cause bleeding, pancreatitis, shortness of breath. The risk of delayed effects of Combivir, such as cancer or mutation in genetic material, is unknown.


Precautions

Therapy with Combivir should be given only with careful consideration of risks and benefits for persons with the following:

1. Previous allergic reaction to Combivir (zidovudine or lamivudine) or similar medication.
   
   
2. Moderate to severe low white blood cell count, low platelet count or anemia.
   
   
3. Kidney disease
   
   
4. Liver disease
   
   
5. Pregnancy: The exact risk of fetal toxicity during pregnancy due to exposure to Combivir not known. It is recommended that women avoid becoming pregnant and that men avoid impregnating their partner during treatment with Combivir and for six months after treatment.
   
   
6. Nursing mothers: It is not known whether Combivir is excreted in human breast milk; therefore, it is recommended that nursing mothers avoid breast feeding while receiving Combivir therapy.
   
   

Treatment Instructions

• Combivir tablet contains zidovudine 300 mg plus lamivudine 150 mg.
  
  
• Dosage: take one tablet every 12 hours (or twice a day), on an EMPTY stomach (without food).
  
  
• Store at room temperature in a dry, dark place in a tightly closed bottle.
  
  
• Take the medication exactly as prescribed by the doctor. If you are having difficulty taking the medication as directed, contact the physician in OHS.
  
  
• If you miss a dose, take the missed dose as soon as you remember it and continue your regular dosing schedule. Space the missed dose and the regularly scheduled dose 2 to 3 hours apart.
  
  
• Other medications, including over the counter medications such as acetaminophen (Tylenol), should not be taken without first consulting your clinician.
  
  
• Keep follow up appointments in OHS every 2 weeks during the 4 week treatment course for exam and lab work.
  
  
• Call the physician in OHS if you have any questions or concerns about this medication, at 746-4370. During hours that OHS is closed, call the Center for Special Studies (CSS) at 746-4180 and ask for the physician on call.