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Sulfa-Associated Rash and Race are Risk Factors for Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-Associated Rash M. DERISI*, C. BALLARD, K. ABULHOSN, B. COLWELL, E. BARBER, and W. C. MATHEWS.
Univ. of California San Diego Med. Ctr., Owen Clin Aim: To identify risk factors for NNRTI-associated rash in a clin. care population.
Background: Nevirapine (NVP), delavirdine (DLV), and efavirenz (EFV) were associated with rash in 18-37% of patients in clin. trials. Trimethoprim/ sulfamethoxazole (TMP/SMX) induces a clinically similar rash, occurring about ten times as often among HIV-infected patients than among uninfected patients.
Methods: Retrospective analysis of a clin. cohort initiating or changing antiretroviral therapy with a NNRTI-containing regimen between June 1996 and April 1999. Demographic and clin. characteristics, including prior sulfa exposure and subsequent presence or absence of rash were examined as potential risk factors for NNRTI-associated rash using logistic regression.
Results: 436 patients met inclusion criteria. Patient characteristics included: 87% male; by race, 14% African-American, 21% Hispanic, 60% Caucasion, 5% other; median (range) CD4+ lymphocyte count 173 (0-1101); by NNRTI exposure, 50% NVP, 44% EFV, 6% DLV. The prevalence of NNRTI-associated rash varied from 8.4% (EFV) to 14.4% (NVP) (p=0.17). According to prior sulfa experience, the incidence of NNRTI-associated rash increased from 5% (prior sulfa and no rash), to 13% (no prior sulfa exposure), to 28% (prior sulfa and rash) (p<0.0001). By race, the incidence of NNRTI rash varied from 6% in African-American patients to 20% in Hispanic patients (p=0.028). Among those with prior sulfa exposure (n=373), in a multiple logistic regression model, prior sulfa rash and Hispanic descent were independent risk factors for NNRTI rash; odds ratios were 8 (95% CI 3.8-16.9) and 2.6 (95% CI 1.2-5.8), respectively.
Conclusions: The incidence of NNRTI-associated rash is significantly influenced by sulfa history and Hispanic race. Gender, CD4 count, and choice of NNRTI were not found to be significant predictors.
Key Words: Antiretroviral, complications, NNRTI
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