AIDS Meeting Hears Ways to Shield Health, Safety Workers

In San Francisco, a doctor caring for a seriously ill AIDS patient accidentally jabs herself with a contaminated needle.

In Orange County, both a police officer and his suspect are injured in a scuffle. Blood from the suspect’s head spatters the officer’s lacerated arm. And several days later, the suspect tests positive for the AIDS virus.

Had these incidents occurred a year ago, the doctor and officer could only wait--and agonize--about whether they would develop AIDS.

But health experts at an AIDS conference held in Anaheim on Wednesday said that San Francisco General Hospital, the Orange County Health Care Agency and a handful of institutions around the nation recently started an experimental program aimed at preventing AIDS in health and safety workers who risk “occupational exposures” to the virus. Under protocols begun in July at San Francisco General, health care workers are offered an intensive, four-week treatment with the antiviral drug AZT immediately after exposure, said Dr. Julie L. Geberding, who directs the hospital’s AIDS virus counseling and testing service. Geberding developed the program with Dr. David K. Henderson from the National Institutes of Health.

Also known as zidovudine, AZT is approved by the Food and Drug Administration for fully developed AIDS or advanced AIDS-related complex. The drug has caused toxic side effects, including anemia.

But Geberding and Henderson noted in a recent medical-journal article that the side effects of AZT should not be too severe during a short-term course of treatment--and that the drug might prevent the AIDS infection from becoming established.

Still, animal studies on this have been “inconclusive,” Geberding said. And she said she established that AZT dosage for the exposed workers “completely by guess.”

At San Francisco General, exposed workers can call a “needle-stick hot-line” number, and if their exposure is judged significant, they are offered counseling--as well as the opportunity to take large doses of AZT within 24 hours of exposure, Geberding said.

She noted that health workers probably had a greater work-related risk of getting hepatitis than of contracting AIDS. Still, she said, those stuck with an AIDS-contaminated needle have a 4% chance of becoming infected with the virus.

In Orange County, health officials don’t have a “hot line,” but any police officer, firefighter or county employee who believes that he has been exposed to the AIDS virus may telephone a county physician 24 hours a day, county AIDS coordinator Penny Weissmuller said at a conference workshop for paramedics and police officers.

Most such incidents have involved being jabbed with needles, Weissmuller said, sometimes as officers searched intravenous drug users for weapons. One involved a police officer who had “an altercation with a suspect” in a flower bed, she said. The suspect cut his head, she said, and his blood spattered the officer’s cut arm. The suspect subsequently tested positive for the AIDS virus.

Weissmuller described the latter incident as a “massive” contamination. The officer was the first and only county worker to take AZT, free, hoping to prevent development of AIDS.

The Orange County Health Care Agency’s AZT program began in October for workers who report a “high risk” exposure within four days of the incident. Since then, said county occupational health physician Loretta Lee, there have been 19 cases of exposure involving police officers, sheriff’s deputies, health care workers, paramedics and a district attorney’s investigator. But none of these were significant enough exposures to require AZT, Lee said.

Reaction at the conference to the Orange County plan was mixed. Orange firefighter Dennis Weaver, a paramedic, said he wasn’t sure AZT would be effective. Added Orange paramedic Frank Eickhoff, “You can’t worry about AIDS. But you need to worry about protection--being really careful with needles, not recapping needles.”

But Charles Smith, an Orange County firefighter from Laguna Hills, noted that he was accidentally stuck by a needle several weeks ago. The elderly woman whom he had been treating was “real low risk” for AIDS, “but I reported it anyway, and I was offered AZT. If she was high risk, I would have taken it. It’s a good idea. . . . I don’t have to live with the fear.”

Wednesday’s conference, “AIDS on the Front Line,” was the third Orange County AIDS conference sponsored by the county Health Care Agency and other agencies that work with AIDS victims. The event drew more than 350 people--a mix of doctors, firefighters, nurses, psychologists, dentists and mothers of AIDS victims.