Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome. Issue 4 (25th November 2016)

• Record Type: Journal Article
• Authors: Manzini, Thandekile Cecilia; Gosnell, Bernadett Isabel; John, Melanie-Anne Amanda; Moosa, Mahomed Yunus Suleman
• Is Part Of: Southern African journal of infectious diseases. Volume 31:Issue 4(2016)
• Page Start: 119
• Page End: 121
• Publication Date: 2016-11-25
• Subjects: efavirenz -- nevirapine -- Stevens-Johnson Syndrome; Epidemiology -- Periodicals; Communicable diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 616.905
• DOI: 10.1080/23120053.2016.1156874
• Languages: English
• ISSNs: 2312-0053

Abstract

Abstract : Background: Non-nucleoside reverse transcriptase inhibitors (NNRTI) are recommended as part of first-line treatment by the World Health Organisation (WHO) for antiretroviral treatment (ART) naïve subjects. Due to reports of cross-toxicity between nevirapine (NVP) and efavirenz (EFV), there is reluctance to substitute EFV for NVP when serious toxicity occurs. In such cases lopinavir/ritonavir (LPV/r) remains the only alternative. We report on our experience of patients with Stevens-Johnson Syndrome (SJS) secondary to NVP who were challenged with EFV under careful supervision. Methods: A retrospective chart review of patients who presented with SJS presumed to be secondary to NVP who were challenged with EFV and were followed up for at least 2 months. Results: The study included 13 patients. All were female, median age 28 years and median weight 66.5 kg. The median CD4 cell count at ART initiation was 160 cells/μl. Twelve patients (92%) developed a rash within 4 weeks of NVP. The median alanine transaminase at SJS presentation was 30 U/l. The median time to EFV challenge was 30 days. The median hospital stay for SJS was 30 days and median follow up was 19 months. Eleven (85%) patients tolerated co-trimoxazole rechallenge, two had no prior exposure. Median hospital stay for EFV challenge was additional 10 days. Twelve patients (92%) tolerated the EFV challenge. One patient developed a pruritic maculo-papular eruption within 3 days of challenge which led to discontinuation of EFV. Conclusion: The risk of recurrence of SJS with EFV challenge in patients with NVP induced SJS is low. It is safe to challenge patients with EFV with careful observation.