Clinical Profile of Adverse Cutaenous Drug Reactions in Patients with Human Immunodeficiency Virus

Abstract

Background: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs. Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage. Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%). Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs.

Mucocutaneous manifestations of HIV/AIDS infection: literature review

“…This is supported by previous studies, which stated that morbilliform eruptions and SJS were found in more than half of HIV/ AIDS patients with CD4+ counts <200 cells/µL. 23 Several drugs were associated with morbilliform eruptions, such as ARTs, trimethoprim-sulfamethoxazole (TMP/SMX), and anti-tuberculosis drugs. The prevalence of morbilliform eruptions due to ART is approximately 10-17%, 7 TMX/SMP approximately 2.6-8%, and anti-tuberculosis drugs approximately 73%.…”

“…22 A retrospective study by Maharani et al reported that non-nucleoside reverse transcriptase inhibitors (NNRTI) ARTs, namely efavirenz (26.7%) and nevirapine (14.5%) were the most common causes of ACDR. 23 The most common reported incidence of ACDR due to antituberculosis drugs was pyrazinamide, followed by streptomycin, ethambutol, rifampin, and isoniazid. 22…”

The Relationship of Comorbid Diseases to the Severity of Allergy Drug Eruption (ADE) at Saiful Anwar Hospital Malang in 2018-2020

“…In addition, antibiotics are also the drugs most often cause severe ADE in HIV patients according to Maharani et al in their journal. Thus, ADE patients who have a history of drug allergies, especially antibiotics, should be given attention because these antibiotics may be one of the drugs that cause patients to develop ADEs, especially in ADE patients who have comorbidities such as HIV (11,12,13).…”