Treatment of Recurring Cutaneous Drug Reactions in Patients With Human Immunodeficiency Virus 1 Infection

Dolev, Jacqueline C.; Reyter, Ilya; Maurer, Toby

doi:10.1001/archderm.140.9.1051

Cited by 10 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They present during the first 8 weeks of therapy, coinciding with a rise in CD4 cell counts, and occur as a manifestation of immune reconstitution. The use of a protracted course of steroids (0.5 mg/kg for the first 8 weeks of therapy) in patients who develop recurrent and potentially severe cutaneous eruptions and have a previous history of ACDR allows suppression of reactions whilst initiating and continuing essential drugs [66].…”

Section: Details and Discussionmentioning

confidence: 99%

An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS

et al. 2019

View full text Add to dashboard Cite

Background: The global mortality from HIV and the cutaneous burden of infective, inflammatory and malignant diseases in the setting of AIDS have significantly declined following the advent of highly active antiretroviral therapy. Regrettably, there has been a contemporaneous escalation in the incidence of adverse cutaneous drug reactions (ACDR), with studies attesting that HIV-positive individuals are a hundred times more susceptible to drug reactions than the general population, and advanced immunodeficiency portending an even greater risk. Several variables are accountable for this amplified risk in HIV. Summary: Adverse reactions to trimethoprim-sulfamethoxazole are the most common, increasing from approximately 2–8% in the general population over to 43% amongst HIV-positive individuals to approximately 69% in subjects with AIDS. Antituberculosis drugs and antiretrovirals are also well-known instigators of ACDR. Cutaneous reactions range from mild morbilliform eruptions to severe, life-threatening manifestations in the form of Stevens-Johnson syndrome/toxic epidermal necrolysis. Histological features vary from vacuolar interface changes to full-thickness epidermal necrosis with subepidermal blister formation. A precipitous diagnosis of the ACDR, clinically and histologically if necessary, together with the isolation of the causative drug is critical. The identification process, however, is often complex and multifaceted due to polypharmacy and inconclusive data on which drugs are the most likely offending agents, especially against the background of tuberculosis co-infection. Key Messages: Whilst milder cutaneous reactions are treated symptomatically, severe reactions mandate immediate treatment discontinuation without rechallenge. Further studies are required to establish safe rechallenge guidelines in resource-limited settings with a high HIV and tuberculosis prevalence.

show abstract

Section: Details and Discussionmentioning

confidence: 99%

An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Extended (8-week) courses of corticosteroids were successfully used to manage three HIV-infected patients with multiple cutaneous drug reactions; steroids facilitated the introduction of antiretroviral therapy that was not previously tolerated in two of these patients. 186 Prednisone therapy also enabled a patient with multiple hypersensitivity reactions to protease inhibitors to continue saquinavir use without significant complication. 187 However, prednisolone has been found not to be helpful in preventing the hypersensitivity reaction to abacavir, 188 and Roujeau and colleagues demonstrated that corticosteroids pose their own intrinsic risk for SJS, having a multivariate relative risk of 4.4 (95% CI, 1.9-10.0).…”

Section: Discussionmentioning

confidence: 99%

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

Miller¹,

Warshaw²

2007

Dermatitis

View full text Add to dashboard Cite

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.

show abstract

“…Although this article focuses primarily on dermatologic effects of individual antiretrovirals, HIV patients may have recurrent cutaneous reactions from multiple medications. Successful management of these particularly difficult drug reactions can be achieved with systemic corticosteroids for the initial 8 weeks of HAART (typical time period of immune reconstitution) (87).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous effects of highly active antiretroviral therapy in HIV-infected patients

Kong

Myers

2005

Dermatol Ther

View full text Add to dashboard Cite

Effective highly active antiretroviral therapy (HAART) has increased survival in patients infected with the human immunodeficiency virus (HIV). However, HAART is not without toxicities. Cutaneous adverse reactions from antiretroviral agents have become increasingly important to recognize as the population of patients surviving with HIV infection grows. Dermatologists play an important role in managing these cutaneous effects of HAART therapy in HIV patients. This article reviews cutaneous adverse effects from nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and fusion inhibitors, as well as separately addresses lipodystrophy, and immune reconstitution.

show abstract

Treatment of Recurring Cutaneous Drug Reactions in Patients With Human Immunodeficiency Virus 1 Infection

Cited by 10 publications

References 17 publications

An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS

An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS

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

Cutaneous effects of highly active antiretroviral therapy in HIV-infected patients

Contact Info

Product

Resources

About