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To the Editor: We agree with the perspective of Drs Merchant and Mayer in their Commentary¹ that the new Centers for Disease Control and Prevention (CDC) guidelines for provision of human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis (HIV NPEP)² represents an important initial step in advising clinicians. However, we note an important caveat with regard to the choice of antiretroviral agents, as discussed in the clinical guidelines developed by the New York State Department of Health AIDS Institute (NYSDOH AI) in 1997 and updated in December 2004.^3-4

The CDC now endorses 3-drug HIV NPEP regimens rather than 2-drug regimens, as does the NYSDOH AI. Yet, the CDC’s suggestion of efavirenz as an anchor of the simplest 3-drug regimens is concerning. In some resource-limited countries, efavirenz may be the only viable option to complete a postexposure prophylaxis regimen. However, in the United States, the Food and Drug Administration recently reclassified efavirenz . . . [Full Text of this Article]

Geoffrey A. Weinberg, MD
geoff_weinberg@urmc.rochester.edu
Department of Pediatrics

Amneris E. Luque, MD
Department of Medicine
University of Rochester School of Medicine & Dentistry
Rochester, NY

Sheldon T. Brown, MD
Department of Medicine
Mount Sinai School of Medicine
New York, NY

For the members of the Steering Committee, New York State Department of Health AIDS Institute, HIV Clinical Guidelines Program, New York, NY.

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