Clinical Profile of Cutaneous Adverse Drug Reactions in HIV Patients: A Cross-sectional Study

Abstract

Introduction: Cutaneous Adverse Drug Reaction (cADR) is one of the most common clinical presentation in patients with Acquired Immunodeficiency Syndrome (AIDS). These patients are more prone to get cADR because of various factors like altered drug metabolism, immune dysregulation, genetic predisposition, polypharmacy and oxidative stress. So, a methodical study of cADR, including the risk factors, patterns of drug eruption and prognostic factors is of crucial clinical significance. Aim: To determine the prevalence of cutaneous drug reactions in Human Immunodeficiency Virus (HIV) patients and also study the various patterns of cADRs. Materials and Methods: This cross-sectional study was conducted at the outpatient department of Infectious diseases and Medical Centre, Voluntary health services, Chennai, Tamil Nadu, India, from April 2020 to December 2020. A total of 150 HIV patients above 18 years who were taking Anti-retroviral Therapy (ART) were included in this study. After screening for cADR, it was classified as Morbilliform eruption, Erythema multiforme, Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Fixed Drug Eruption (FDE) etc., The severity of the reaction was graded based on Modified Hartwig and Siegel severity assessment scale. Pearson Chi‑square test and Bivariate Pearson Correlation was performed to statistically analyse the data. Results: Amongst total of 150 HIV patients (87 males and 63 females), mean age of the study population was 41.07 years. There was a male predominance with male:female ratio of 1.3:1. About 44% (n=6) of the study population had opportunistic infection. The prevalence of drug eruption in this study was found to be 6% (n=9). Out of which, 55.6% (n=5) of the population had morbilliform eruption and 22.7% had urticarial (n=2) and pruritus (n=2) respectively. About 56% (n=5) of the drug reaction was caused by Tenofovir/Lamivudine/Efavirenz regimen and the remaining 44% (n=4) of the drug eruption was caused by Abacavir/Lamivudine/Dolutegravir regimen. Conclusion: In this study, the prevalence of drug eruption was 6% and majority of the population had morbilliform eruption.

Keywords

• human immunodeficiency virus
• immune response
• oxidative stress
• skin reaction