title: Lamivudine-Induced Skin Rash Remains an Underdiagnosed Entity in HIV: A Case Series from a Single Center.
abstract: BACKGROUND
  Hypersensitivity reaction to antiretroviral treatment (ART) poses potential threats in maintenance of treatment. Lamivudine (3TC), is rare to cause rash. We are reporting 23 cases of 3TC-induced rash.
  
  
  METHODS
  An observational study conducted in the antiretroviral treatment center of a tertiary care hospital of North India from Feb 2009-Dec 2013 to record 3TC-induced rash. These were then recommended to start ART without 3TC and were followed up at 1-, 2-, and at 4-week intervals to monitor the toxicity, if any, with alternate therapy.
  
  
  RESULTS
  We observed 3TC-induced skin rash in 23 HIV-infected individuals (0.7%), out of 3213 HIV-infected individuals initiated on first line ART (zidovudine [ZDV]/tenofovir [TDF] + 3TC +nevirapine [NVP]/efavirenz [EFV] during the study period of 5 years [Feb 2009-Dec 2013]). The mean age of these 23 individuals was 37.5 ± 12.8 (17-60) years. Lamivudine rash was more common in women than men (F = 19, M = 4), with an overall mean age of 37.5 ± 12.8 (17-60) years. It was generalized, erythematous, maculopapular eruptions associated with intense itching with no associated mucosal involvement. Lamivudine was substituted with TDF in 19, didanosine (ddl) in 3 and abacavir (ABC) in 1 individual. Mean duration of follow-up is 11.1 ± 12.8 (3-42) months. CD4 count was repeated at 3 months and showed significant improvement (P = 0.002).
  
  
  CONCLUSIONS
  Lamivudine-induced rash was found at a frequency of 0.7%. The correct and early recognition that the rash is due to 3TC, would save unnecessary substitution to a different class of drugs.
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors: Ravinder Kaur
authors: RK
authors: Sachdeva
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India amansharma74@yahoo.com.
authors: Aman
authors: A
authors: Sharma
authors: Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors: Dipankar
authors: D
authors: De
authors: National AIDS Control Organization, New Delhi, India.
authors: Jasjit
authors: J
authors: Malhi
authors: National AIDS Control Organization, New Delhi, India.
authors: Bharat Bhushan
authors: BB
authors: Rewari
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors: Surjit
authors: S
authors: Singh
authors: Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors: Subhash
authors: S
authors: Varma
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D005076:Exanthema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007194:India / Q000453:epidemiology; D019259:Lamivudine / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine
keywords: 3TC; HIV/AIDS; hypersensitivity; lamivudine; rash