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Incidence and risk factors of rash associated with efavirenz in HIV‐infected patients with preceding nevirapine‐associated rash
Author(s) -
Manosuthi W,
Thongyen S,
Chumpathat N,
Muangchana K,
Sungkanuparph S
Publication year - 2006
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2006.00396.x
Subject(s) - nevirapine , efavirenz , medicine , rash , interquartile range , discontinuation , incidence (geometry) , odds ratio , viral load , immunology , human immunodeficiency virus (hiv) , antiretroviral therapy , physics , optics
Objective To determine the incidence and risk factors of rash associated with efavirenz in HIV‐infected patients with preceding nevirapine‐associated rash. Methods A retrospective cohort study was conducted in HIV‐infected patients diagnosed with nevirapine‐associated rash who subsequently received efavirenz between July 2003 and January 2005. Patients were followed up for 3 months after receiving efavirenz. Possible risk factors, including demographics, previous opportunistic infections, CD4 cell count, viral load, severity of nevirapine‐associated rash and concurrent drugs, were studied and compared between those who had (group A) and did not have (group B) rash associated with efavirenz. Results A total of 122 patients (52.5% male) were included in the study, with a mean age of 38.2 years. Median (and interquartile range) CD4 cell count and viral load were 55 (20–167) cells/μL and 86 150 (35 321–700 750) HIV‐1 RNA copies/mL, respectively. Of the 122 patients, 10 (8.2%) developed rash associated with efavirenz and all required discontinuation of efavirenz. The baseline characteristics of group A (10 patients) and group B (112 patients) were similar. Median (and interquartile range) time from nevirapine discontinuation to efavirenz initiation was 12 (9–21) days in group A and 11 (7–21) days in group B ( P= 0.765). None of the risk factors investigated was associated with developing rash associated with efavirenz. The preceding development of severe nevirapine‐associated rash had a trend towards a higher rate in group A than in group B (20.0% vs 10.7%; odds ratio=2.08; 95% confidence interval 0.39–10.97; P =0.322). Conclusions The majority (>90%) of HIV‐infected patients with CD4 counts <200 cells/μL who had preceding nevirapine‐associated rash could tolerate efavirenz well. Efavirenz may be an option for subsequent use in these patients, particularly in those who had preceding nevirapine‐associated rash.