Cutaneous eruptions associated with nevirapine therapy in AIDS cases

The aim was to study the cutaneous adverse effects of nevirapine (NVP). One hundred ten patients on NVP based regimen were enrolled in the study and monitored for adverse reactions (ADR). A detailed history of every patient was taken including past history of antiretroviral treatment. All patients were clinically evaluated and treated for opportunistic infections. Three drug regimen (Zidovudine/ Stavudine + Lamivudine + NVP) was prescribed to all cases having CD4 count < 200 cells/mm 3 or clinically symptomatic cases. NVP was given in a lead in dose (200 mg once daily) for initial 15 days. If no hypersensitivity was seen then dose was increased to 200 mg twice daily. NVP induced rash was observed in 13 cases (11.8%). Rash was the commonest ADR of NVP and was graded according to standard guidelines. Stevens Johnson syndrome (grade IV rash) was observed in 3 cases. In 7 cases NVP was substituted by Efavirenz (EFV) while 2 cases continued with 2 drugs due to lack of resources. Two cases stopped treatment. Clinicians should always start the NVP in lead-in dose and closely monitor patients on NVP based regimen especially during the first two months of therapy.