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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Prednisolone does not prevent hypersensitivity reactions in antiretroviral drug regimens containing abacavir with or without nevirapine
AIDS, Volume 15, No. 18, Year 2001
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Description
Objectives: To determine the effect of adjuvant prednisolone use on the development of abacavir (ABC)- and nevirapine (NVP)-associated hypersensitivity reactions (HSR). Methods: Randomized open-label study in antiretroviral-naive adult HIV-1 infected patients using a factorial design in which NVP and/or hydroxyurea (HU) and/or prednisolone are added to a regimen of ABC, zidovudine and lamivudine. Prednisolone (40 mg once daily) was added for the first 2 weeks of treatment. As it was difficult to distinguish ABC-associated HSR from NVP-associated HSR, these events were treated as a composite endpoint. The odds ratio (OR) of developing HSR for prednisolone-use was calculated with and without stratification by NVP and/or HU. Logistic regression was performed to identify risk factors for developing HSR. Results: Of the 229 patients 115 were randomized to prednisolone and 114 to noprednisolone; 19 (17%) and 11 (10%) patients, respectively, developed HSR. The expected prevention of HSR by prednisolone use was not observed. In fact use of prednisolone showed an increased risk for HSR although this did not reach statistical significance [OR, 1.82; 95% confidence interval (Cl), 0.82-4.03]. There was a higher incidence of HSR in the NVP group than in the non-NVP group (20% versus 6%; P = 0.002). An additional risk factor identified in a multivariate logistic model was a high baseline CD4 cell count (OR, 1.26 per 100 × 106cells/l increase; 95% Cl, 1.06-1.51). Conclusions: The simultaneous start of ABC and NVP in first-line antiretroviral regimens should be avoided because of a high (20%) incidence of HSR. Short-term therapy with prednisolone did not prevent HSR in patients using ABC with or without NVP. © 2001 Lippincott Williams & Wilkins.
Authors & Co-Authors
Wit, Ferdinand W.N.M.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Wood, Robin Y.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Horban, Andrzéj
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Beniowski, Marek
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Schmidt, Reinhold Ernst
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Gray, Glenda E.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Lazzarin, Adriano
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
de Vries, Corry
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
van Leeuwen, Remko
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Lange, Joep M.A.
Netherlands, Amsterdam
Amsterdam Umc - University of Amsterdam
Statistics
Citations: 36
Authors: 10
Affiliations: 1
Identifiers
Doi:
10.1097/00002030-200112070-00010
ISSN:
02699370
Research Areas
Infectious Diseases
Study Design
Cohort Study
Case-Control Study