Drug reaction with eosinophilia and systemic symptoms related to antiretroviral treatment in human immunodeficiency virus patients

Abstract

Background:The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening condition caused by different medications. The objective of this study was to analyze DRESS cases related to antiretroviral therapy in human immunodeficiency virus (HIV) patients.Materials and Methods:Systematic review of DRESS suspected cases in HIV patients associated to antiretrovirals published between January 1998 and April 2017. The registry of the severe cutaneous adverse reactions score was used to classify each report as a “definitive,” “probable,” “possible,” or “no” DRESS case. Clinical characteristics, management, and outcomes were evaluated.Results:Thirty-five case reports were analyzed involving 5 antiretrovirals: Abacavir in 10 (28.6%) cases, efavirenz in 6 (17.1%), nevirapine in 12 (34.3%), raltegravir in 6 (17.1%), and tenofovir in 1 (2.9%). Mean age of the patients was 40 ± 13 years, 65% of which were male. A total of 57.1% reports were classified as having a “definitive-probable” DRESS case. Management was based on withdrawal of the causal antiretroviral and corticosteroids in 68.6% of the cases. None of the patients died. Treatment with nevirapine or raltegravir, the longer onset of symptoms and the presence of lymphadenopathy, eosinophilia, liver involvement, and a longer time for clinical resolution were more frequent among “definitive-probable” DRESS cases.Conclusions:A DRESS syndrome has to be suspected in HIV patients with lymphadenopathy, eosinophilia, and liver involvement developing weeks after the initiation of nevirapine or raltegravir. Suspension of the causal antiretroviral and in most cases treatment with corticosteroids allowed adequate clinical control.

<p>A Unique Case Of Tenofovir-Induced DRESS Syndrome Associated With Raynaud’s Of The Tongue</p>

“…Various medications have been implicated in triggering DRESS syndrome with phenytoin, carbamazepine, and phenobarbital being the most common 14. It has also been associated with antiretroviral therapy15; however, tenofovir-induced DRESS has been reported only once in literature 4. Our patient was started on tenofovir two months earlier, developed a skin eruption with liver failure shortly thereafter, was found to have elevated eosinophils in his blood, a skin biopsy showing spongiotic dermatitis with eosinophilia, and a complete resolution of symptoms within 10 days of discontinuation of the medication.…”

Eosinophilia and Kidney Disease: More than Just an Incidental Finding?

“…A potential parasite-endemic risk should be assessed to rule out Strongyloides or Schistosoma infection and in the case of suspected infection empirical therapy with ivermectin or praziquantel may be considered [183,184]. Reported cases of HIV-infected patients with PBE and impaired kidney function are usually a consequence of the side effects, toxicity, or hypersensitivity reactions of antiretroviral treatment [185,186,187]. Thomas et al propose an association of HLA-B*53:01, a prevalent allele among African individuals, with the risk of raltegravir-induced DRESS syndrome [188].…”

“…Thomas et al propose an association of HLA-B*53:01, a prevalent allele among African individuals, with the risk of raltegravir-induced DRESS syndrome [188]. A systematic review of DRESS-cases in HIV-patients found five different antiretrovirals in 35 reported cases [187]. Eosinophilia was seen in 51.4% (18/35) of the cases, while 28.6% (10/35) of the cases presented with kidney affection.…”