Severe antiretroviral‐associated skin reactions in South African patients: a case series and case–control analysis

Stewart, Alexander; Lehloenya, Rannakoe; Boulle, Andrew; Waal, Reneé de; Maartens, Gary; Cohen, Karen

doi:10.1002/pds.4067

Cited by 18 publications

(20 citation statements)

References 55 publications

(126 reference statements)

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“…During this study, nevirapine induced severe skin reactions, such as erythematous rash, in six cases (18.8%), Steven Johnson Syndrome (SJS) in four cases (12.6%), and toxic epidermal necrolysis (TEN) in one case. This finding is similar to the findings of Stewart A et al (36) In our study, erythematous rash was moderate in severity and occurred within 4 weeks of nevirapine-based HAART regimen. The suspected drug nevirapine was then withdrawn, and symptomatic treatment was initiated.…”

Section: Discussionsupporting

confidence: 93%

Highly Active Antiretroviral Therapy Induced Hematological and Dermatological Adverse Drug Reactions in People Living with HIV in India

Varma

Rajesh

Pulagam

et al. 2018

IMMINV

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Introduction: In India, HIV patients are at a high risk of developing hematological and dermatological adverse drug reactions (ADRs) leading to financial burden. Materials and Methods: A prospective observational study was conducted on hematological and dermatological ADRs in a South Indian teaching hospital from October 2011 to October 2012. The definition of ADRs established by the World Health Organization (WHO) was used to assess the causality. Predictability of ADRs was assessed by Micromedex database. Preventability of ADRs was assessed using the Schumock and Thornton criteria. Results: A total of 174 HIV patients were enrolled [133 (76.4%) males and 41 (23.6%) females], who reported 99 ADRs to HAART. Of the total ADRs, 70 (70.7%) were reported in males and 29 (29.3%) in females, indicating significantly higher reporting of ADRs in males. 67 of the 99 ADRs were hematological, while the remaining 32 were dermatological. A high number of hematological [40 (59.6%)] and dermatological [15 (46.8%)] ADRs were reported for zidovudine + lamivudine + nevirapine-based HAART regimen. In most of the reported ADRs, the suspected drug was withdrawn. The reported hematological ADRs were as follows: 1) anemia with zidovudine [35 (52.2%)]; 2) pancytopenia with zidovudine [20 (29.9%)]; 3) neutropenia with lamivudine; and 4) leucopenia, bicytopenia, and eosinophilia with zidovudine. Dermatological ADRs were maculopapular rash [7 (21.8%)] with nevirapine-, tenofovir + emtricitabine + efavirenz. Conclusion: Hematological ADRs was higher than that of dermatological ADRs. Physicians must focus on routine monitoring of all possible risk factors in PLW-HIV for early prevention of hematological and dermatological ADRs to HAART.

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Section: Discussionsupporting

confidence: 93%

Highly Active Antiretroviral Therapy Induced Hematological and Dermatological Adverse Drug Reactions in People Living with HIV in India

Varma

Rajesh

Pulagam

et al. 2018

IMMINV

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“…IM-ADR to HAART is well recognized with the highest prevalence being CADRs to nonnucleoside reverse transcriptase inhibitors (NNRTIs). These occur in ~15% of patients starting treatment, and a significant portion are severe cutaneous adverse drug reactions (SCAR), most commonly epidermal necrolysis and drug rash with eosinophilia and systemic symptoms (DRESS); as well as drug-induced liver injury (DILI) to nevirapine [7][8][9]. CADRs to NRTIs, such as tenofovir and emtricitabine are most recently described in large postexposure prophylaxis cohorts, when used in two-drug fixed dose combination [10].…”

Section: Epidemiology Of Drug Hypersensitivity: An Evolving Landscapementioning

confidence: 99%

Drug hypersensitivity in HIV infection

Peter

Choshi

Lehloenya

2019

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review-Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. Recent findings-Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight. Summary-IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches.

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“…A literature search using PubMed and OVID of the terms “AGEP,” “acute generalized exanthemous pustulosis,” and “African American,” “black,” and “African” for AGEP and African Americans returned six cases. Most of the cases involved polypharmacy (4/6) or an immunosuppressed state (4/6) [ 4 , 17 - 20 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis in an African American Male Caused by Trimethoprim-Sulfamethoxazole

Bressler

Minkowitz

Pathak

et al. 2020

Cureus

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Acute generalized exanthematous pustulosis (AGEP) is a rare drug-induced autoimmune disease that presents with hundreds of sterile pustules and systemic symptoms. Genetic predisposition, race, and medications prescribed are all factors in AGEP's frequency, which occurs most commonly in Caucasians and with the use of macrolides and aminopenicillins. Cases of AGEP with sulfonamides or in African American patients are rare. To our knowledge, this is the first documented example of trimethoprim-sulfamethoxazole-induced AGEP in an African American male. In this article, we will further discuss our case and review the literature.

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Severe antiretroviral‐associated skin reactions in South African patients: a case series and case–control analysis

Abstract: Severe skin reactions resulted in prolonged admission to hospital in this setting. We found that nevirapine use and pregnancy are independently associated with severe skin reaction. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 18 publications

References 55 publications

Highly Active Antiretroviral Therapy Induced Hematological and Dermatological Adverse Drug Reactions in People Living with HIV in India

Highly Active Antiretroviral Therapy Induced Hematological and Dermatological Adverse Drug Reactions in People Living with HIV in India

Drug hypersensitivity in HIV infection

Acute Generalized Exanthematous Pustulosis in an African American Male Caused by Trimethoprim-Sulfamethoxazole

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