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October 5, 2005

Nonoccupational HIV Postexposure Prophylaxis—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(13):1615-1616. doi:10.1001/jama.294.13.1615-b

In Reply: We agree with Drs Weinberg, Luque, and Brown that efavirenz is not an optimal choice for nonoccupational HIV NPEP in women who are or may become pregnant. Unfortunately for clinicians’ decision-making, data are limited on the relative efficacy of any HIV NPEP regimen. This limitation forces clinicians to choose regimens based on the best available evidence that can be extracted from studies involving persons already infected with HIV, as well as from mother-to-child HIV transmission prevention studies, basic science research, and HIV NPEP investigations that are not randomized, controlled trials. For example, Schechter et al1 educated a cohort of men who had sex with men to take zidovudine/lamivudine for NPEP after high-risk exposures and demonstrated a lower incidence of HIV seroconversion compared with those who did not take HIV NPEP; however, the trial did not include other HIV NPEP regimens. As a result, this study provides additional proof-of-concept for HIV NPEP but not direction on which regimen is best.