Journal article

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

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Publication Details

Author list: Stewart A, Lehloenya R, Boulle A, de Waal R, Maartens G, Cohen K

Publisher: Wiley

Publication year: 2016

Journal: Pharmacoepidemiology and Drug Safety


Volume number: 25

Issue number: 11

Start page: 1313

End page: 1319

Total number of pages: 7

ISSN: 1053-8569

eISSN: 1099-1557


PurposeSevere skin reactions may complicate combination antiretroviral therapy (cART). Nevirapine is known to be associated with severe skin reactions, but there are conflicting data on risk factors in African patients. We reviewed cases of severe skin reactions admitted to a tertiary hospital in Cape Town, South Africa. We identified associations with severe skin reactions in patients on cART.MethodsWe described severe skin reaction cases in patients taking cART admitted to Groote Schuur Hospital in Cape Town, South Africa, between 2006 and 2012. We included those patients who developed a severe skin reaction within 120days of cART initiation in a case-control analysis. We identified control patients matched on date of cART initiation and primary care facility by linkage with the Western Cape electronic provincial HIV database. We conducted a conditional (fixed effects) logistic regression modelling.ResultsWe identified 169 severe skin reactions in patients on cART. The most common presentations were Stevens Johnson syndrome/toxic epidermal necrolysis (49%) and drug hypersensitivity syndrome (36%). One hundred forty-one patients were female, of which 27 were pregnant. Median duration of hospitalization was 12days (interquartile range 8 to 19) and six patients died. We included 91 cases and 361 matched controls in the analysis. Severe skin reaction was associated with nevirapine exposure, adjusted odds ratio of 7.6 (95%CI 3.7 to 15.7) and with pregnancy, adjusted odds ratio 3.7 (95%CI 1.3 to 10.8) compared with men.ConclusionsSevere 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 (c) 2016 John Wiley & Sons, Ltd.


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AIDS, Antiretroviral, HIV

Last updated on 2017-21-04 at 17:50