Hasan Maryatun, Yunihastuti Evy, Teguh H Karjadi, Abdullah Murdani
Department of Internal Medicine, Faculty of Medicine, Universitas Syiah Kuala/ZainoelAbidin Hospital, Aceh, Indonesia.
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/CiptoMangunkusumo Hospital, Jakarta, Indonesia.
Asian Pac J Allergy Immunol. 2022 Jun;40(2):141-146. doi: 10.12932/AP-080719-0596.
Many drugs used for the treatment of HIV disease can cause drug hypersensitivity reactions. Since 2002, World Health Organization (WHO) has recommended the use of nevirapine and efavirenz as part of first line antiretroviral therapies for several years. Both of the drugs had equivalent clinical efficacy but differences in toxicity profile.
We aimed to determine the incidence and predictors of nevirapine and efavirenz-associated rash among Indonesian HIV-infected patients.
A retrospective cohort study was conducted among Indonesian patients who were using nevirapine or efavirenz between January 2004 to December 2013. All eligible predictors were analyzed using bivariate and multivariate analysis.
2,071 patients received nevirapine and 1,212 received efavirenz as first line therapies. The cumulative incidence of nevirapine-associated rash was 14% (95%CI: 12.5-15.5%) and evafirenz-associated rash was 4.5% (95%CI: 3.4-5.8%). Severe reactions occurred 1% patients receiving NVP and 0.1% patients receiving EFV, but no patients died due to these conditions. Predictors independently related with nevirapine-associated rash were female gender (adjusted RR = 1.622; 95%CI: 1.196-2.199; p = 0.002), baseline absolute CD4 count above 200 cells/mm3 (adjusted RR = 1.387; 95%CI: 1.041-1.847; p = 0.025), and hepatitis C co-infection (adjusted RR = 1.507; 95%CI: 1.138-1.995; p = 0.004). Baseline ALT level > 1.25 times upper normal limit (adjusted RR = 1.508; 95%CI: 0.998-2.278; p = 0.051) had a tendency to be a good predictor. None of the risk factors investigated was associated with developing efavirenz-associated rash.
Female, baseline absolute CD4 count above 200 cells/mm3, hepatitis C co-infection and baseline ALT levels more than 1.25 times upper normal limit were predictors for nevirapine-associated rash in HIV patients.
许多用于治疗HIV疾病的药物可引起药物过敏反应。自2002年以来，世界卫生组织（WHO）多年来一直推荐使用奈韦拉平和依非韦伦作为一线抗逆转录病毒疗法的一部分。这两种药物具有同等的临床疗效，但毒性特征有所不同。
我们旨在确定印度尼西亚HIV感染患者中奈韦拉平和依非韦伦相关皮疹的发生率及预测因素。
对2004年1月至2013年12月期间使用奈韦拉平或依非韦伦的印度尼西亚患者进行了一项回顾性队列研究。所有符合条件的预测因素均采用双变量和多变量分析。
2071例患者接受奈韦拉平作为一线治疗，1212例患者接受依非韦伦作为一线治疗。奈韦拉平相关皮疹的累积发生率为14%（95%CI：12.5 - 15.5%），依非韦伦相关皮疹的累积发生率为4.5%（95%CI：3.4 - 5.8%）。1%接受奈韦拉平治疗的患者和0.1%接受依非韦伦治疗的患者发生了严重反应，但没有患者因此死亡。与奈韦拉平相关皮疹独立相关的预测因素为女性（调整后RR = 1.622；95%CI：1.196 - 2.199；p = 0.002）、基线绝对CD4细胞计数高于200个/mm3（调整后RR = 1.387；95%CI：1.041 - 1.847；p = 0.025）以及丙型肝炎合并感染（调整后RR = 1.507；95%CI：1.138 - 1.995；p = 0.004）。基线ALT水平>正常上限的1.25倍（调整后RR = 1.508；95%CI：0.998 - 2.278；p = 0.051）有成为良好预测因素 的趋势。所调查的危险因素均与依非韦伦相关皮疹的发生无关。
女性、基线绝对CD4细胞计数高于200个/mm3、丙型肝炎合并感染以及基线ALT水平超过正常上限的1.25倍是HIV患者中奈韦拉平相关皮疹的预测因素。
