Incidence and Determinants of Nevirapine and Efavirenz-Related Skin Rashes in West Africans: Nevirapine's Epitaph?
Identifieur interne : 000472 ( Main/Exploration ); précédent : 000471; suivant : 000473Incidence and Determinants of Nevirapine and Efavirenz-Related Skin Rashes in West Africans: Nevirapine's Epitaph?
Auteurs : Fred Stephen Sarfo [Ghana] ; Maame Anima Sarfo [Ghana] ; Betty Norman [Ghana] ; Richard Phillips [Ghana] ; David Chadwick [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Agents antiVIH (effets indésirables), Benzoxazines (effets indésirables), Exanthème (), Exanthème (diagnostic), Exanthème (épidémiologie), Facteurs de risque, Femelle, Ghana (épidémiologie), Humains, Incidence, Indice de gravité médicale, Mâle, Névirapine (effets indésirables), Études rétrospectives.
- MESH :
- diagnostic : Exanthème.
- effets indésirables : Agents antiVIH, Benzoxazines, Névirapine.
- épidémiologie : Exanthème, Ghana.
- Adulte, Adulte d'âge moyen, Exanthème, Facteurs de risque, Femelle, Humains, Incidence, Indice de gravité médicale, Mâle, Études rétrospectives.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Adult, Anti-HIV Agents (adverse effects), Benzoxazines (adverse effects), Exanthema (chemically induced), Exanthema (diagnosis), Exanthema (epidemiology), Female, Ghana (epidemiology), Humans, Incidence, Male, Middle Aged, Nevirapine (adverse effects), Retrospective Studies, Risk Factors, Severity of Illness Index.
- MESH :
- chemical , adverse effects : Anti-HIV Agents, Benzoxazines, Nevirapine.
- geographic , epidemiology : Ghana.
- chemically induced : Exanthema.
- diagnosis : Exanthema.
- epidemiology : Exanthema.
- Adult, Female, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Factors, Severity of Illness Index.
Abstract
Non-nucleoside reverse transcriptase inhibitor (NNRTI) associated rash is common and frequently leads to discontinuation of NNRTIs. This study assessed the risk of developing rashes and discontinuing NNRTIs and associated factors in a large clinic in central Ghana. In this retrospective cohort study, clinical data were obtained in patients starting efavirenz or nevirapine between 2004–2010. Factors associated with rashes were explored using a multivariate Cox proportional hazards regression model. Of 3,999 patients who started NNRTI-based ART, 281 (7.0%) experienced at least one episode of NNRTI-related rash with an incidence of 2.63 events/100 person-years, occurring in 10.2% and 5.6% of patients taking nevirapine and efavirenz respectively. Most rashes (94%) were grade 1 or 2 and were reported a median of 2 months following initiation of ART. In multivariate analysis developing a rash was associated with nevirapine use (aHR 1.67, 95% CI 1.28–2.10), female gender (aHR of 1.39, 95% CI 1.01–1.92) and lower baseline CD4 counts (aHR 0.88, 95% CI 0.82–0.95 per 50 cells/mm3 increment). Patients with nevirapine-associated rash were 11 times more likely to discontinue treatment as patients with efavirenz-associated rash. In contrast to findings in other studies, NNRTI-associated rashes in Ghanaians appear more common in patients with lower baseline CD4 counts. Given the increased frequency of rashes with nevirapine and subsequent discontinuations in many patients, along with other treatment-limiting toxicities, this provides further impetus for the replacement of nevirapine by efavirenz as the first-line NNRTI treatment of choice in Africa.
Url:
DOI: 10.1371/journal.pone.0094854
PubMed: 24728406
PubMed Central: 3984248
Affiliations:
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Medicine, Kwame Nkrumah University of Science and Technology, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Sarfo, Maame Anima" sort="Sarfo, Maame Anima" uniqKey="Sarfo M" first="Maame Anima" last="Sarfo">Maame Anima Sarfo</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Norman, Betty" sort="Norman, Betty" uniqKey="Norman B" first="Betty" last="Norman">Betty Norman</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medicine, 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Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Chadwick, David" sort="Chadwick, David" uniqKey="Chadwick D" first="David" last="Chadwick">David Chadwick</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Centre for Clinical Infection, The James Cook University Hospital, Middlesbrough, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Clinical Infection, The James Cook University Hospital, Middlesbrough</wicri:regionArea><wicri:noRegion>Middlesbrough</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Anti-HIV Agents (adverse effects)</term><term>Benzoxazines (adverse effects)</term><term>Exanthema (chemically induced)</term><term>Exanthema (diagnosis)</term><term>Exanthema (epidemiology)</term><term>Female</term><term>Ghana (epidemiology)</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Nevirapine (adverse effects)</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Severity of Illness Index</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Agents antiVIH (effets indésirables)</term><term>Benzoxazines (effets indésirables)</term><term>Exanthème ()</term><term>Exanthème (diagnostic)</term><term>Exanthème (épidémiologie)</term><term>Facteurs de risque</term><term>Femelle</term><term>Ghana (épidémiologie)</term><term>Humains</term><term>Incidence</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Névirapine (effets indésirables)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Anti-HIV Agents</term><term>Benzoxazines</term><term>Nevirapine</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Exanthema</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Exanthema</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Exanthème</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Agents antiVIH</term><term>Benzoxazines</term><term>Névirapine</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Exanthema</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Exanthème</term><term>Ghana</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Severity of Illness Index</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Exanthème</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Indice de gravité médicale</term><term>Mâle</term><term>Études rétrospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Non-nucleoside reverse transcriptase inhibitor (NNRTI) associated rash is common and frequently leads to discontinuation of NNRTIs. This study assessed the risk of developing rashes and discontinuing NNRTIs and associated factors in a large clinic in central Ghana. In this retrospective cohort study, clinical data were obtained in patients starting efavirenz or nevirapine between 2004–2010. Factors associated with rashes were explored using a multivariate Cox proportional hazards regression model. Of 3,999 patients who started NNRTI-based ART, 281 (7.0%) experienced at least one episode of NNRTI-related rash with an incidence of 2.63 events/100 person-years, occurring in 10.2% and 5.6% of patients taking nevirapine and efavirenz respectively. Most rashes (94%) were grade 1 or 2 and were reported a median of 2 months following initiation of ART. In multivariate analysis developing a rash was associated with nevirapine use (aHR 1.67, 95% CI 1.28–2.10), female gender (aHR of 1.39, 95% CI 1.01–1.92) and lower baseline CD4 counts (aHR 0.88, 95% CI 0.82–0.95 per 50 cells/mm<sup>3</sup> increment). Patients with nevirapine-associated rash were 11 times more likely to discontinue treatment as patients with efavirenz-associated rash. In contrast to findings in other studies, NNRTI-associated rashes in Ghanaians appear more common in patients with lower baseline CD4 counts. Given the increased frequency of rashes with nevirapine and subsequent discontinuations in many patients, along with other treatment-limiting toxicities, this provides further impetus for the replacement of nevirapine by efavirenz as the first-line NNRTI treatment of choice in Africa.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Fellay, J" uniqKey="Fellay J">J Fellay</name></author><author><name sortKey="Boubaker, K" uniqKey="Boubaker K">K Boubaker</name></author><author><name sortKey="Ledergerber, B" uniqKey="Ledergerber B">B Ledergerber</name></author><author><name sortKey="Bernasconi, E" uniqKey="Bernasconi E">E Bernasconi</name></author><author><name sortKey="Furrer, H" uniqKey="Furrer H">H Furrer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="D Arminio Monteforte, A" uniqKey="D Arminio Monteforte A">A d'Arminio 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uniqKey="Cingolani A">A Cingolani</name></author><author><name sortKey="Zaccarelli, M" uniqKey="Zaccarelli M">M Zaccarelli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Griensven, J" uniqKey="Van Griensven J">J van Griensven</name></author><author><name sortKey="Zachariah, R" uniqKey="Zachariah R">R Zachariah</name></author><author><name sortKey="Rasschaert, F" uniqKey="Rasschaert F">F Rasschaert</name></author><author><name sortKey="Mugabo, J" uniqKey="Mugabo J">J Mugabo</name></author><author><name sortKey="Atte, Ef" uniqKey="Atte E">EF Atte</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Montaner, Js" uniqKey="Montaner J">JS Montaner</name></author><author><name sortKey="Reiss, P" uniqKey="Reiss P">P Reiss</name></author><author><name sortKey="Cooper, D" uniqKey="Cooper D">D Cooper</name></author><author><name sortKey="Vella, S" uniqKey="Vella S">S Vella</name></author><author><name sortKey="Harris, M" uniqKey="Harris M">M Harris</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li></country></list><tree><country name="Ghana"><noRegion><name sortKey="Sarfo, Fred Stephen" sort="Sarfo, Fred Stephen" uniqKey="Sarfo F" first="Fred Stephen" last="Sarfo">Fred Stephen Sarfo</name></noRegion><name sortKey="Norman, Betty" sort="Norman, Betty" uniqKey="Norman B" first="Betty" last="Norman">Betty Norman</name><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><name sortKey="Phillips, Richard" sort="Phillips, Richard" uniqKey="Phillips R" first="Richard" last="Phillips">Richard Phillips</name><name sortKey="Sarfo, Fred Stephen" sort="Sarfo, Fred Stephen" uniqKey="Sarfo F" first="Fred Stephen" last="Sarfo">Fred Stephen Sarfo</name><name sortKey="Sarfo, Maame Anima" sort="Sarfo, Maame Anima" uniqKey="Sarfo M" first="Maame Anima" last="Sarfo">Maame Anima Sarfo</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Chadwick, David" sort="Chadwick, David" uniqKey="Chadwick D" first="David" last="Chadwick">David Chadwick</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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