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To the Editor: The article by Dr Lurie and colleagues¹ on postexposure prophylaxis (PEP) for persons exposed to human immunodeficiency virus (HIV) in nonoccupational settings raises important clinical and public health issues. However, the methods suggested to determine the likelihood that the source patient is HIV positive, including use of local research studies and seroprevalence data, are problematic.

In most geographic areas, local research that can provide accurate population-based estimates of HIV seroprevalence is unlikely to be available. On a national level, recent seroprevalence data are similarly sparse.² Changes in the epidemiology of acquired immunodeficiency syndrome (AIDS) cases reported to the Centers for Disease Control and Prevention's National AIDS Case Surveillance System during recent years suggest that this time lag may be a significant factor.³ However, even timely data from seroprevalence surveys are fraught with the potential for selection bias, making extrapolation to groups other than the one undergoing testing . . . [Full Text of this Article]

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