Rotunda Adam, Hirsch Ranella J, Scheinfeld Noah, Weinberg Jeffrey M
Department of Dermatology, State University of New York Health Science Center at Brooklyn, Brooklyn, NY, USA.
Acta Derm Venereol. 2003;83(1):1-9. doi: 10.1080/00015550310002611.
Patients infected with human immunodeficiency virus are highly susceptible to adverse dermatological reactions to specific medications. Severe cutaneous conditions such as Stevens-Johnson syndrome and toxic epidermal necrolysis are associated with high morbidity and, notably for toxic epidermal necrolysis, high mortality. Although overall mortality from human immunodeficiency virus has dramatically declined owing to highly active antiretroviral therapy, these antiretroviral regimens have been associated with a wide spectrum of severe cutaneous reactions. We reviewed case reports and clinical trials in the English literature on Medline (1966 to 2001) and Aidsline (1980 to 2000) to determine the prevalence of Stevens-Johnson syndrome and toxic epidermal necrolysis attributable to the current FDA approved antiretroviral medications. We identified a total of approximately 50 patients who had Stevens-Johnson syndrome and/or toxic epidermal necrolysis associated with the use of 5 antiretroviral medications: 2 nucleoside reverse transcriptase inhibitors, zidovudine (2 patients) and didanosine (1 patient); 1 non-nucleoside reverse transcriptase inhibitor, nevirapine (42 patients); and 2 protease inhibitors, indinavir (1 patient) and amprenavir (an unspecified number within the 1% of over 1400 patients experiencing severe life-threatening reactions). Of the reports that specified the onset time of adverse reaction after initiation of treatment, 86% (19/22) of patients experienced reactions within 4 weeks. Ten of the approximately 50 patients were diagnosed with Stevens-Johnson syndrome or toxic epidermal necrolysis, due to specific antiretroviral medication, or a combination of medications identified by either resolution upon withdrawal, consistent biopsy findings or a positive rechallenge. The remainder of the identified patients were reported in articles lacking data regarding drug administration, reaction history or other details.
感染人类免疫缺陷病毒的患者极易对特定药物产生不良皮肤反应。严重的皮肤疾病，如史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症，发病率很高，尤其是中毒性表皮坏死松解症，死亡率也很高。尽管由于高效抗逆转录病毒疗法，人类免疫缺陷病毒的总体死亡率已大幅下降，但这些抗逆转录病毒治疗方案却与多种严重的皮肤反应有关。我们查阅了医学在线数据库（1966年至2001年）和艾滋病在线数据库（1980年至2000年）英文文献中的病例报告和临床试验，以确定目前美国食品药品监督管理局批准的抗逆转录病毒药物所致史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症的患病率。我们共识别出约50例患有史蒂文斯-约翰逊综合征和/或中毒性表皮坏死松解症的患者，这些患者使用了5种抗逆转录病毒药物：2种核苷类逆转录酶抑制剂，齐多夫定（2例患者）和去羟肌苷（1例患者）；1种非核苷类逆转录酶抑制剂，奈韦拉平（42例患者）；以及2种蛋白酶抑制剂，茚地那韦（1例患者）和安普那韦（在1400多名经历严重危及生命反应的患者中，有1%出现严重反应，但未明确具体人数）。在明确了治疗开始后不良反应发生时间的报告中，86%（19/22）的患者在4周内出现反应。在这约50例患者中，有10例被诊断为史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症，病因是特定的抗逆转录病毒药物或多种药物联合使用，通过停药后症状缓解、活检结果一致或再次用药激发试验阳性得以确定。其余已识别的患者在文章中报告，但缺乏有关药物使用、反应史或其他细节的数据。
