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1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV26–28 June 1999 - San Diego, CA, USA |
THE FREQUENCY OF RASH DURING THE INITIAL USE OR UPON RECHALLENGE WITH NEVIRAPINE AND DELAVIRDINE
Antiviral Therapy 1999; 4(Suppl. 2):50(abstract no. 32)
JG O'Brien1, M Gangar1, G Arias1 and CA Kemper1,2,3
1Division of Infectious Diseases, Department of Medicine, Santa Clara Valley Medical Center, San Jose; 2Department of Medicine, Stanford University School of Medicine, Stanford; and 3the AIDS Community Research Consortium (ACRC), Redwood City, California, USA
Patients attending a public hospital outpatient HIV clinic, which serves a predominately hispanic community, who were receiving either nevirapine or delavirdine appeared to be experiencing a high incidence of rash and disproportionate number of severe reactions. We reviewed the medical records of 89 patients who had received either nevirapine or delavirdine from March 1997 to July 1998. Three quarters of the patients had AIDS, and nearly 17% were female. The overall incidence of rash was 37% (60.6% mild, 21.2% moderate, 18.2% severe). Sixty-nine patients initially received nevirapine and 20 patients initially received delavirdine. While rash due to delavirdine was more frequent, that due to nevirapine was more severe and resulted in more frequent hospitalization. Five patients (7.2%) receiving nevirapine developed severe and/or life-threatening rash, four of whom were hospitalized. Including two patients with severe angio-oedema and fever, and one patient each with Stevens-Johnson syndrome, erythema multiforme, and severe morbilliform rash with nausea, vomiting and fever. The medication was successfully continued in only six (24%) patients who developed mild rash to nevirapine. There was a trend towards higher frequency of rash in women, 46.7% versus 35.1% for men (P=0.40), and possibly for hispanics 46% versus 27.9% non-hispanic (P=0.08). Neither HIV status, CD4 count, nor plasma HIV RNA levels were significant predictors for the development of rash. Fever preceded rash in 21 % of patients receiving nevirapine. Drug was discontinued in 19% of patients receiving nevirapine and 24% receiving delavirdine because of rash. Rash recurred in 80% of patients who were rechallenged with the same agent and in 67% of patients crossed-over to the alternate agent, suggesting that there is probably little value in attempting to retreat patients with cutaneous reactions, even with the alternate agent, except in those patients with limited treatment options.
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Copyright © 1999 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.