Prednisolone does not prevent the occurrence of nevirapine-induced rashes

Rey, David; Partisani, Marialuisa; Krantz, Véronique; Kempf, Georg; Nicolle, M.; Mautort, E de; Priester, M; Bernard-Henry, Claudine; Lang, J. M.

doi:10.1097/00002030-199911120-00016

Cited by 25 publications

(6 citation statements)

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“…Rey et al [6] showed that prednisolone had no beneficial effect for the prevention of nevirapine-induced rashes, and Antinori et al [8] identified female sex and the use of antiallergic agents (glucocorticoids and antihistamines) as risk factors for developing cutaneous rash associated with nevirapine therapy [8]. Recently, the only prospective, randomized study of this topic showed that short-term therapy with prednisone does not prevent nevirapine-associated rash and might even increase its incidence and severity [12].…”

Section: Discussionmentioning

confidence: 99%

“…In the main trials of nevirapine-containing regimens, the most common side effect (occurring in 9%-32% of the patients) was the development of rash, usually within the first 4-6 weeks of therapy; the drug discontinuation rate was 6%-7%, and the incidence of Stevens-Johnson syndrome was ∼1% [1][2][3][4]. The benefit of preventive treatment using antihistamines or corticosteroids is unclear [6][7][8]. In the same studies, hepatotoxicity was noted in 2%-5% of patients who received nevirapine, but the rate was not significantly different than the rate for patients who did not receive nevirapine [1][2][3][4].…”

Section: (mentioning

confidence: 99%

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A Cohort Study of Nevirapine Tolerance in Clinical Practice: French Aquitaine Cohort, 1997–1999

et al. 2002

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We performed a retrospective study to evaluate, under routine circumstances, the tolerance and immunovirological changes associated with antiretroviral regimens that contain nevirapine in 137 patients (88% were antiretroviral experienced). During a mean follow-up of 11 months, 33% of patients reported side effects attributed to nevirapine, and 21% discontinued treatment because of poor tolerance. Administration of antihistamines or corticosteroids at the initiation of treatment was not protective against adverse events (relative risk, 0.82; 95% confidence interval, 0.49-1.38). The proportion of patients with hepatitis C virus (HCV) and/or hepatitis B virus (HBV) coinfection who had alanine aminotransferase levels of >100 IU/L increased from 19.4% at baseline to 42.9% at month 12 of follow-up (P=.02). We noticed a significant increase of the proportion of patients with total cholesterol levels of >5.5 mM (P=.02). We have shown that there is a high level of discontinuation of nevirapine therapy in clinical practice and that side effects were not prevented by administration of antihistamines or corticosteroids. Coinfection with HCV or HBV increased the risk of hepatotoxicity, which lead to the cautious use of nevirapine for such patients.

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Section: Discussionmentioning

confidence: 99%

Section: (mentioning

confidence: 99%

A Cohort Study of Nevirapine Tolerance in Clinical Practice: French Aquitaine Cohort, 1997–1999

et al. 2002

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“…57 One trial demonstrated a protective effect for corticosteroids against nevirapine rash, 190 but numerous subsequent studies found no effect or found a paradoxical increase in the rash rate. 191 Demoly and colleagues suggested a possible mechanism for this observation when they noted that nevirapine is metabolized by CYP450-3A, which is induced by glucocorticoids. 46 They hypothesized that steroids may increase nevirapine metabolism and production of reactive metabolites, leading to increased rash.…”

Section: Discussionmentioning

confidence: 99%

Adverse Cutaneous Reactions to Antimicrobials in Patients with Human Immunodeficiency Virus Infection

Miller¹,

Warshaw²

2007

Dermatitis

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Adverse reactions to medication are significant contributors to morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. Cutaneous events not only constitute a significant portion of these reactions, they may also herald developing systemic reactions such as hemato-, nephro-, and hepatotoxicity. The identification of cutaneous adverse reactions and drug culprits and the proper management of reactions are of paramount importance for these patients. This review focuses specifically on adverse cutaneous reactions to antimicrobials that are commonly used in the management of patients with HIV infection.

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“…Introducing the drug using stepwise dose escalation reduces the risk of such a reaction. Conversely, the use of prednisolone does not offer any protection and in some studies has been associated with an increased risk of hypersensitivity 28 . Hepatotoxicity May occur with nevirapine use and has even been associated with death in a minority of cases.…”

Section: Treatment Guidelinesmentioning

confidence: 99%

HIV Revisited: The Global Impact of the HIV/AIDS Epidemic

Amy

Lee

Amy

et al. 2004

Skinmed

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This review is intended as an update on modern trends in the global impact and epidemiology of human immunodeficiency virus infection for physicians who are not acquired immunodeficiency syndrome experts. Africa has been the most affected, but epidemics are spreading in Asia and Russia. Therefore, physicians should be informed about seroconversion disease and human immunodeficiency virus diagnosis as well as the impact of sexually transmitted infections on many stages of human immunodeficiency virus. International treatment guidelines are available. Highly active antiretroviral therapy has been the mainstream therapy since 1996, but all drugs--regardless of class used--have potent side effects, many of which are dermatologic. Others affect the neurologic, hematopoietic, cerebral, and abdominal systems, and drug interactions are common. Lipodystrophy is a common, long-term side effect that is still not well understood. Broader use of highly active antiretroviral therapy has highlighted viral resistance. This is reviewed, and a simple explanation of therapeutic monitoring is provided.

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Prednisolone does not prevent the occurrence of nevirapine-induced rashes

Cited by 25 publications

References 5 publications

A Cohort Study of Nevirapine Tolerance in Clinical Practice: French Aquitaine Cohort, 1997–1999

A Cohort Study of Nevirapine Tolerance in Clinical Practice: French Aquitaine Cohort, 1997–1999

Adverse Cutaneous Reactions to Antimicrobials in Patients with Human Immunodeficiency Virus Infection

HIV Revisited: The Global Impact of the HIV/AIDS Epidemic

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