HOPE Research Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Am J Clin Dermatol. 2012 Feb 1;13(1):49-54. doi: 10.2165/11593240-000000000-00000.
The incidence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) has been reported to be between 0.95 and 1 per 1000 individuals with AIDS. Accessibility to a cohort of individuals with HIV with known drug exposure (including drug, dose, and time of exposure) and collection of adverse-event information may provide an opportunity to determine an incidence rate of SJS and TEN.
The primary objective of this analysis was to determine the incidence of confirmed SJS and TEN in a cohort of Canadian HIV patients who were receiving HIV and HIV-related medications.
This was a retrospective analysis of an HIV cohort.
The Ontario HIV Treatment Network (OHTN) cohort population was eligible for this analysis.
A search of the OHTN database was conducted to determine whether cases with a diagnosis of SJS or TEN were included. Search terms included 'TEN,' 'SJS,' 'epidermal necrolysis,' and 'erythema multiforme.' All SJS and TEN cases recorded in the OHTN database between January 1995 and August 2008 were obtained. Diagnostic criteria for SJS and TEN were established and two reviewers examined the medical records to confirm the SJS or TEN diagnosis. Drug exposure and utilization were documented. Incidence rates for the entire cohort were calculated.
Seventeen cases over seven OHTN study sites were identified from an approximate cohort sample size of 3700. There were 15 men (88%). The mean ± SD age was 51.6 ± 11.3 years and time since HIV diagnosis was 16.1 ± 4.4 years. Only one patient reported experiencing a previous SJS or TEN episode. Of the 17 cases, clinical experts diagnosed five cases as true SJS and/or TEN, two cases were labeled as indeterminant, and the remaining cases were considered not SJS or TEN. Among the confirmed cases, drugs taken included nevirapine, trimethoprim/sulfamethoxazole (cotrimoxazole), stavudine (d4T), and clarithromycin.
The incidence of SJS and/or TEN was 5-7 per 3710 or approximately 1-2 per 1000 individuals in this cohort with HIV. Careful diagnosis of this adverse event is required for an accurate measure of incidence and to avoid false inflation of the incidence.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）的发病率据报道在艾滋病患者中为每 1000 人中有 0.95 至 1 人。获得已知药物暴露（包括药物、剂量和暴露时间）的 HIV 感染者队列以及收集不良事件信息可能为确定 SJS 和 TEN 的发病率提供机会。
本分析的主要目的是确定接受 HIV 和 HIV 相关药物治疗的加拿大 HIV 患者队列中确诊 SJS 和 TEN 的发病率。
这是对 HIV 队列的回顾性分析。
安大略省 HIV 治疗网络（OHTN）队列人群符合本分析条件。
对 OHTN 数据库进行了搜索，以确定是否包括 SJS 或 TEN 诊断的病例。搜索词包括“TEN”、“SJS”、“表皮坏死松解症”和“多形性红斑”。从 1995 年 1 月至 2008 年 8 月 OHTN 数据库中获得所有记录的 SJS 和 TEN 病例。确定了 SJS 和 TEN 的诊断标准，两名审查员检查了病历以确认 SJS 或 TEN 诊断。记录了药物暴露和使用情况。计算了整个队列的发病率。
从大约 3700 名队列样本中，在七个 OHTN 研究地点共发现了 17 例。其中 15 例为男性（88%）。平均年龄为 51.6 ± 11.3 岁，HIV 诊断后时间为 16.1 ± 4.4 年。只有 1 例患者报告曾发生过先前的 SJS 或 TEN 发作。在 17 例病例中，临床专家诊断了 5 例为真正的 SJS 和/或 TEN，2 例为不确定，其余病例被认为不是 SJS 或 TEN。在确诊病例中，服用的药物包括奈韦拉平、甲氧苄啶/磺胺甲噁唑（复方新诺明）、司他夫定（d4T）和克拉霉素。
在该 HIV 队列中，SJS 和/或 TEN 的发病率为每 3710 人中有 5-7 例，约为每 1000 人中有 1-2 例。为了准确衡量发病率并避免发病率的虚假膨胀，需要对这一不良事件进行仔细诊断。
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