title: Incidence and risk factors of nevirapine-associated skin rashes among HIV-infected patients with CD4 cell counts <250 cells/microL.
abstract: The objective of the study was to determine cumulative incidence and risk factors of nevirapine (NVP)-associated rashes that lead to NVP discontinuation among HIV-infected patients with CD4 <250 cells/microL. A retrospective cohort study was conducted among antiretroviral-naïve HIV-infected patients who had baseline CD4 <250 cells/microL and were initiated NVP-based antiretroviral therapy (ART) between January 2003 and October 2005. There were 910 patients with a mean age of 35.4 years and 43% were women. Median CD4 cell count was 27 cells/microL and median HIV RNA was 5.5 log copies/mL. Cumulative incidences of rashes at 0.5, 1, 2, 3 and 6 months after ART were 3.7%, 6.2%, 8.1%, 8.5% and 8.5%, respectively. By Kaplan-Meier analysis, the higher baseline CD4 cell counts had a higher probability of NVP-associated rashes (log-rank test, P=0.041). By Cox regression analysis, higher baseline CD4 cell count was associated with a higher incidence of rashes (hazard ratio=1.244, 95% confidence interval=1.045-1.482, for every 50 cells/microL increment of baseline CD4 stratum). In conclusion, NVP-associated skin rashes that lead to NVP discontinuation are common among HIV-infected patients with baseline CD4 <250 cells/microL. Despite the low baseline in this population, the higher number of baseline CD4 cells is continuously associated with a higher risk for skin rashes.
authors.affiliation: Department of Medicine, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand. idweerawat@yahoo.com
authors.forename: Weerawat
authors.initials: W
authors.lastname: Manosuthi
authors.forename: Somnuek
authors.initials: S
authors.lastname: Sungkanuparph
authors.forename: Somsit
authors.initials: S
authors.lastname: Tansuphaswadikul
authors.forename: Yaowarat
authors.initials: Y
authors.lastname: Inthong
authors.forename: Wisit
authors.initials: W
authors.lastname: Prasithsirikul
authors.forename: Suthat
authors.initials: S
authors.lastname: Chottanapund
authors.forename: Wiroj
authors.initials: W
authors.lastname: Mankatitham
authors.forename: Sukanya
authors.initials: S
authors.lastname: Chimsuntorn
authors.forename: Chayanan
authors.initials: C
authors.lastname: Sittibusaya
authors.forename: Visal
authors.initials: V
authors.lastname: Moolasart
authors.forename: Nopphanath
authors.initials: N
authors.lastname: Chumpathat
authors.forename: Patamavadee
authors.initials: P
authors.lastname: Termvises
authors.forename: Achara
authors.initials: A
authors.lastname: Chaovavanich
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005076:Exanthema / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use*; D012044:Regression Analysis; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D019829:Nevirapine