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Pinkerton et al¹ conclude that postexposure prophylaxis is cost-effective after moderate- to high-risk occupational exposure to human immunodeficiency virus. They analyzed a 28-day course of zidovudine, lamivudine, and indinavir, which is currently recommended by the US Public Health Service for patients with high-risk exposure.² Baseline assumptions included wholesale drug costs but not the costs associated with adverse drug effects. However, the cost-utility ratio was sensitive to treatment cost.¹

The analysis by Pinkerton et al was in press when the Food and Drug Administration issued a public health advisory reporting 83 cases of diabetes and/or hyperglycemia associated with the use of protease inhibitors (including indinavir).³ The average onset of hyperglycemia was 76 days after initiation of protease inhibitor therapy, but cases occurred as early as 4 days. Hyperglycemia persisted in some cases after protease inhibitor therapy was discontinued. I am aware of no reports of diabetes associated with postexposure prophylaxis regimens . . . [Full Text of this Article]

Steven David Pinkerton, PhD; David Robert Holtgrave, PhD; Heidi Jill Pinkerton, MD
Milwakee, Wis

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