Prospective evaluation of risk factors of cutaneous drug reactions to sulfonamides in patients with AIDS

• Published in: Journal of the American Academy of Dermatology 2002-07, Vol.47 (1), p.40-46
• Main Authors: Eliaszewicz, Muriel, Flahault, Antoine, Roujeau, Jean-Claude, Fillet, Anne Marie, Challine, Dominique, Mansouri, Samira, Wolkenstein, Pierre, Aractingi, Sélim, Penso-Assathiany, Dominique, Maslo, Caroline, Bourgault-Villada, Isabelle, Chosidow, Olivier, Caumes, Eric
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; Analysis of Variance; Biological and medical sciences; Case-Control Studies; Comorbidity; Drug Eruptions - diagnosis; Drug Eruptions - epidemiology; Drug Eruptions - etiology; Drug toxicity and drugs side effects treatment; Female; Humans; Incidence; Male; Medical sciences; Multivariate Analysis; Pharmacology. Drug treatments; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - drug therapy; Pneumonia, Pneumocystis - epidemiology; Probability; Prospective Studies; Risk Factors; Sulfonamides - adverse effects; Sulfonamides - therapeutic use; Toxicity: skin, dermoskeleton; Toxoplasmosis - diagnosis; Toxoplasmosis - drug therapy; Toxoplasmosis - epidemiology; Virus Diseases - epidemiology
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1067/mjd.2002.120468

Background: Persons with HIV infection have increased rates of drug eruptions. Objective: Our aim was to evaluate the risk factors of drug eruptions in response to sulfonamides in patients with AIDS, using a case-control analysis. Methods: One hundred thirty-six patients who were hospitalized for pneumocystosis or toxoplasmosis were evaluated at the onset of treatment for various risk factors, which were then compared among patients with (48, 36%) and without (88, 64%) a drug eruption. Results: In multivariate analysis, high CD8+ cell count and age less than 36 years indicated a risk of drug eruption (respective odds ratios: 3.5 [95% CI 1.6-7.8], P = .002, and 2.1 [95% CI 1-4.6], P = .06). Markers of viral replication for HIV, Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and parvovirus B19, slow acetylation phenotype or genotype, and glutathione level were not associated with a risk. Administration of corticosteroids had no preventive effect. Conclusions: Our results challenge several current concepts regarding drug eruptions by discarding a strong association with glutathione deficiency, slow acetylation, or active viral infections and by showing no preventive effect of corticosteroids. (J Am Acad Dermatol 2002;47:40-6.)