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Abstract
Can efavirenz be used in HIV-infected patients with preceding severe cutaneous reactions to nevirapine?
B. Purandare, V. Purandare, D. Padhya, D. Kadam, A. Kakrani
Background: To determine the incidence of rash associated with Efavirenz (EFV) in HIV-infected patients with preceding severe cutaneous reactions to Nevirapine (NVP).
Methods: A retrospective cohort study was done on HIV-infected patients treated between February 2005 to December 2007 as per the guidelines of National AIDS Control Organisation (NACO), Government of India at the ART centre. Patients diagnosed to have NVP associated severe cutaneous reactions (Grade II and above) were subsequently administered EFV. Patients were followed-up at least fortnightly for a minimum of 45 days after starting EFV. In addition to demographic and gender data, CD4 cell count, severity of NVP and EFV cutaneous reactions and concurrent drugs were recorded.
Results: Of 4828 patients enrolled at ART centre, 4056 patients received NVP. 125 patients developed NVP-associated cutaneous reactions. Switching from EFV to NVP after completion of anti-tuberculous treatment was a significant risk factor for development of NVP rash (p=0.002). 102 patients, who had grade II reactions or above [including 43 with Steven Johnson Syndrome (SJS) and 5 with Toxic Epidermal Necrolysis (TEN)], requiring discontinuation of NVP were included in the study. 67% were females and median age was 32 years (range 7-64 years). Median CD4 cell count at NVP initiation was 162.5(14-980) cells/µL. Most patients, even those with SJS/TEN did tolerate EFV well. Of 102 patients, 7 patients (95% CI- 2.8%-13.6%) developed rash associated with EFV and 3 (95% CI- 0.6%-8.4%) required discontinuation of EFV due to grade III rash but none died.
Conclusions: 93% HIV-infected patients with a history of preceding severe cutaneous reactions to NVP can tolerate EFV well. Three percent are at the risk of developing another severe skin-reaction to EFV (95% CI- 0.6%-8.4%). Closely monitored use of EFV may prove to be a cost-effective alternative to protease-inhibitors in patients with NVP-associated severe rash in resource-limited settings.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
THPE0198
Suggested Citation
"B.Purandare, et al.
Can efavirenz be used in HIV-infected patients with preceding severe cutaneous reactions to nevirapine?.
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
THPE0198"
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