Clinical analysis of 97 cases with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with drug eruption caused by antiretroviral treatment

doi:10.3877/cma.j.issn.1674-1358.2018.04.015

Abstract

Abstract:

Objective

To investigate the clinical data of drug eruption induced by antiretroviral drugs in patients with human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS), and to provide reference for the prevention and control.

Methods

The clinical data of 97 HIV/AIDS patients with drug eruption induced by antiretroviral therapy (ART) in Beijing Ditan Hospital, Capital Medical University from November 2008 to December 2016 were analyzed, retrospectively, and patients were devided into efavirenz (EFV) group (63 cases) and nevirapine (NVP) group (34 cases). The age, sex, drug combination, allergies, rashes, incubation period, CD4⁺ T lymphocyte count, eosinophil percentage (EO%) and treatments were analyzed.

Results

The 97 cases aged from 18 to 68 years, including 87 male and 10 female. There were 23 patients with a history of allergies and 69 (74.19%) patients with elevated EO%. The difference of the incidence of serious rash had significant difference (χ²= 12.398,P< 0.001) between the two group (47.06%vs. 14.29%). There were 70.10% patients (68/97) had a rash within two weeks of ART treatment, with 51 cases (81.95%) in EFV group and 17 cases (50.00%) in NVP group, with no significant difference (P> 0.05). The incidence of rash in NVP group was higher than that of EFV group after 2 to 4 weeks of ART treatment (χ²= 4.750,P= 0.029). And 55.67% (54/97) patients with CD4⁺T≤200 cells/μl broke out rashes, and EFV group was higher than that of NVP group (χ²= 4.705,P= 0.030). Among patients with CD4⁺T 201-499 cells/μl, the incidence of rash in NVP group was higher than that in EFV group, with significant difference (χ²= 7.109,P= 0.008). Among patients with CD4⁺T > 500 cells/μl in both group, there was no significant difference (P> 0.05). All patients improved and were discharged after treatment. The percentage of patients who withdrawed drug in NVP group was significantly higher than that of EFV group (79.41%vs. 22.22%;χ²= 7.109,P= 0.008). The proportion of patients receiving glycyrrhizin and glucocorticoid therapy in NVP group was significantly higher than that in EFV group, with significant difference (70.59%vs. 44.44%;χ²= 6.069,P= 0.014).

Conclusions

Although rashes of EFV and NVP had different characteristics, but both commonly occurred within 4 weeks of ART treatment. Rashes induced by NVP were more serious than that of EFV. It is likely to occur in patients with CD4⁺T≤200 cells/μl and the combination of drug types may be a risk factor. EO% of patients increased when drug rash occurs, and EO% could be taken as an indicator to monitor rash occurrence.

Key words: Acquired immuno deficiency syndrome, Antiretroviral therapy, Drug eruption

Lijun Wang, Hanqiu Zhan. Clinical analysis of 97 cases with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with drug eruption caused by antiretroviral treatment[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(04): 392-396.

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References 25

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组别	例数	≤1周	1～2周	2～4周	4～6周	6～8周
EFV组	63	26（41.27）	25（39.68）	10（15.87）	2（3.17）	0（0.00）
NVP组	34	10（29.41）	7（20.59）	12（35.29）	4（12.90）	1（2.94）
χ²值	?	1.330	3.642	4.750	1.523	0.099
P值	?	0.249	0.056	0.029	0.217	0.753

组别	例数	≤1周	1～2周	2～4周	4～6周	6～8周
EFV组	63	26（41.27）	25（39.68）	10（15.87）	2（3.17）	0（0.00）
NVP组	34	10（29.41）	7（20.59）	12（35.29）	4（12.90）	1（2.94）
χ²值	?	1.330	3.642	4.750	1.523	0.099
P值	?	0.249	0.056	0.029	0.217	0.753

组别	行CD4⁺T细胞检测例数	0～200个/μl	201～499个/μl	500～700个/μl	≥700个/μl
EFV组	53	42（79.25）	7（13.21）	4（7.54）	0（0.00）
NVP组	22	12（35.29）	9（26.47）	0（0.00）	1（2.94）
χ²值	?	4.705	7.109	0.578	0.209
P值	?	0.030	0.008	0.447	0.648

组别	行CD4⁺T细胞检测例数	0～200个/μl	201～499个/μl	500～700个/μl	≥700个/μl
EFV组	53	42（79.25）	7（13.21）	4（7.54）	0（0.00）
NVP组	22	12（35.29）	9（26.47）	0（0.00）	1（2.94）
χ²值	?	4.705	7.109	0.578	0.209
P值	?	0.030	0.008	0.447	0.648

组别	行EO%检测例数	升高	正常	降低
EFV组	61	44（69.84）	12（19.05）	5（7.94）
NVP组	32	25（73.53）	6（17.65）	1（2.94）
χ²值	?	0.394	< 0.001	0.252
P值	?	0.530	1.000	0.616

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