Oral lesions associated with nevirapine-related Stevens Johnson syndrome: A report of four cases

Balasundaram, S; Ranganathan, K; Umadevi, K. M. R.; Rajan, Gunaseelan; Kumaraswamy, Nagarathna Hosalli; Solomon, Sunithi; Devaleenol, Bella; Pradeep, Amrose

doi:10.4103/0973-029x.80024

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…Earlier studies [56] (Table 4), have reported increased total bilirubin, conjugate and unconjugated bilirubin as well as elevated levels of cholesterol following NVP administration, pointing towards hepatotoxicity. Result is in line with earlier reports of elevated levels of bilirubin following NVP based treatments [49,52]. Fatal hepatotoxicity including fulminant and cholestatic hepatitis, hepatic necrosis and hepatic failure had also been reported in patients with NVP treatment [7,47,51,53,55,57,58] Increases in liver enzyme (ALT, AST, ALP and GGT) levels imply that NVP administration may impair liver, hamper the integrity and function of the liver in individual users.…”

Section: Effect Of Nvp On Serum Liver Enzymes Profilesupporting

confidence: 79%

Influence of Nevirapine on Gastrointestinal Function

AO¹

2015

J Gastrointest Dig Syst

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In recent times there has been a growing research interest in Nevirapine an antiretroviral medication that prevents human immunodeficiency virus cells from multiplying in the blood. Nevirapine comes as tablet and a suspension (liquid) often taken by mouth, it is taken with or without once a day for 2 weeks and twice a day after the first 2 weeks. It is best to swallow nevirapine with liquids such as water, milk or soda. Feeding experiments in various animal species and humans have highlighted the beneficial role of nevirapine on health. These benefits include significant reduction in acquired immune deficiency syndrome-related morbidity and mortality. However, nevirapine hypersensitivity reaction can lead to morbidity through treatment interruption, inconvenience and loss of productivity. Additionally, nevirapine has an excellent bioavailability and a long half-life. This increases the risk of non-nucleoside reverse transcriptase inhibitor resistance when patients discontinue all the other antiretroviral drugs in the regimen at the same time. Thus, this can lead to decreased therapeutic options if nevirapine resistance develops. The gastrointestinal tract is a major portal of entry of nutrients into the body and nevirapine first make contact with the gastrointestinal tract. The health of an individual is dependent on the nutrient absorbed and hence functional integrity of the gastrointestinal tract. Studies have revealed that the interaction with drug have led to disruption of gastrointestinal function.

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Section: Effect Of Nvp On Serum Liver Enzymes Profilesupporting

confidence: 79%

Influence of Nevirapine on Gastrointestinal Function

AO¹

2015

J Gastrointest Dig Syst

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“…In the Women and Infants Transmission Study (WITS) cohort (1989)(1990)(1991)(1992)(1993)(1994) artificial rupture of membranes (RR 1.06; 95 % CI 0.74-1.53) and exposure to blood during labour (RR 0.7; 95 % CI 0.4-1.27) or delivery (RR 1.06; 95 % CI 0.74-1.52) were not associated with transmission [38]. Also, fetal skin lesions (RR 1.2; 95 % CI 0.7-1.8) and episiotomy/tear (RR 1.0; 95 % CI 0.7-1.3) have not been associated with transmission [39,27].…”

Section: Management Of Labour and Deliverymentioning

confidence: 93%

“…Bone disorders as osteopenia, osteoporosis and osteonecrosis have all been documented. Nevirapine has been associated with mucus membrane /skin eruptions, including Steven Johnson's syndrome [27]. It is therefore essential to monitor haematological and clinical chemistry parameters for patients on antiretroviral.…”

Section: Antiretroviral Treatment In Pregnancymentioning

confidence: 99%

HIV in pregnancy – An update

Chilaka

Konje

2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Human immunodeficiency virus (HIV) is an infection with a global prevalence and currently no cure or vaccine. Women living with HIV who become pregnant or who acquire the virus during pregnancy are at risk of both maternal and perinatal morbidity and mortality mainly if the virus is poorly controlled. Furthermore, there is a risk of vertical transmission to the fetus during pregnancy labour and postpartum through breastfeeding. Appropriate management must be instituted to reduce the consequences of HIV in pregnancy, ideally starting with preconception counselling and planning pregnancies when the viral load is minimum. During pregnancy, an appropriate combined anti-retroviral (cART) medication is mandatory with very close monitoring of the viral load, cluster of differentiation 4 (CD4) cell counts, blood counts, liver and kidney function tests. Planning delivery should not be different in women on cART and suppressed viral loads. However, special care must be taken to limit vertical transmission in those who present late and in whom viral load is unknown or not controlled at the time of delivery. Breastfeeding remains a potential source of infection for the baby and is being discouraged in highincome countries for women living with HIV; however, in low-income countries, the recommendation is exclusive breastfeeding. If breastfeeding must happen, it is best when viral load is suppressed, and cART continued until weaning. Serodiscordant couples present unique problems, and their management should begin with the planning of pregnancy. Emphasis should be on taking steps to prevent HIV transmission to the negative partner and vertical transmission to the newborn .

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“…The spectrum of severe cutaneous adverse drug reactions includes SJS or TEN, hypersensitivity syndrome (HSS), anaphylaxis and angioedema, serum sickness, and cutaneous vasculitis. One of the undesirable side-effects of highly active anti-retroviral therapy (HAART) in HIV management is SJS [6]. Mycoplasma pneumonia infection has also been reported in association with SJS [7].…”

Section: Discussionmentioning

confidence: 99%