Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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.
Mayer KH, Merchant RC. Nonoccupational HIV Postexposure Prophylaxis—Reply. JAMA. 2005;294(13):1615–1616. doi:10.1001/jama.294.13.1615-b
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