Question
What are the symptoms of rash with efavirenz used in PEP?
16 September 2011. Related: All topics, Side effects.
What are the typical efavirenz-induced rash characteristics ?
Under PEP, suffered vast diffuse (75% body surface) macular rash mostly at the back and extremities, erythematous, warm, very itchy, relieved by topical corticosteroid cream, lasted only for 5-6 days, with no other typical acute HIV seroconversion symptoms.
Would you please kindly describe what is the typical characteristics of ARS rash ? Thank you very much.
Answer
Hi
Rash symptoms related to efavirenz can range from very mild to severe. Approximately 15-20% of people experience some form of rash, usually mild and manageable, with less than 5% of people needing to stop treatment.
The following information below is from the summary information from the European licensing information.
I am more concerned that you were prescribed efavirenz as part of a PEP combination.
UK guidelines for PEP, do not recommend NNRTIs (such as efavirenz) because of the low but potentially serious risk of side effects. This may be higher in people who are HIV-negative.
This is also because drug-related rash might be confused with symptoms of seroconversion.
PEP combinations in the UK use a protease inhibitor (PI) boosted by ritonavir plus two nucleoside analogues (nukes). See: UK Department of Health Guidelines for PEP (2008).
Information about efavirenz-related rash from the Summary of Product Characteristics.
From Section 4.4 (page 4)
Rash: mild-to-moderate rash has been reported in clinical studies with efavirenz and usually resolves with continued therapy. Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. Severe rash associated with blistering, moist desquamation or ulceration has been reported in less than 1% of patients treated with efavirenz. The incidence of erythema multiforme or Stevens-Johnson syndrome was approximately 0.1%. Efavirenz must be discontinued in patients developing severe rash associated with blistering, desquamation, mucosal involvement or fever. If therapy with efavirenz is discontinued, consideration should also be given to interrupting therapy with other antiretroviral agents to avoid development of resistant virus (see section 4.8).
From section 4.8c (page 19)
Rash: in clinical studies, 26% of patients treated with 600 mg of efavirenz experienced skin rash compared with 17% of patients treated in control groups. Skin rash was considered treatment related in 18% of patients treated with efavirenz. Severe rash occurred in less than 1% of patients treated with efavirenz, and 1.7% discontinued therapy because of rash. The incidence of erythema multiforme or Stevens-Johnson syndrome was approximately 0.1%.
Rashes are usually mild-to-moderate maculopapular skin eruptions that occur within the first two weeks of initiating therapy with efavirenz. In most patients rash resolves with continuing therapy with efavirenz within one month. Efavirenz can be reinitiated in patients interrupting therapy because of rash. Use of appropriate antihistamines and/or corticosteroids is recommended when efavirenz is restarted.
Experience with efavirenz in patients who discontinued other antiretroviral agents of the NNRTI class is limited. Reported rates of recurrent rash following a switch from nevirapine to efavirenz therapy, primarily based on retrospective cohort data from published literature, range from 13 to 18%, comparable to the rate observed in patients treated with efavirenz in clinical studies. (See section 4.4.)
Hi Bjay,
The rash could be a side effect of either the efavirenz or cotrimoxazol. Therefore, you’ll need to talk to your doctor about this. It is however important that you don’t stop taking your ARVs.
I am currently on my 18th day of ARV with Lamivudine/Tenofovir/Efavirenz. I tolerated the drugs for the past 2 weeks then i suddenly developed rashes on my face, trunk, and extremities now. I dont know if it is due to efavirenz or cotrimoxazole that i take as prophylaxis for PCP. Should i stop the treatment? Thanks
Hi Ruwayda,
How long have you been on meds? What are you taking?
Any rashes should be discussed with your doctor.
Hey am getting now an then a rash on the whole of my body and even on my face what can I do to stop it? Its also itching.
Hi Agness, please speak to a doctor. If you are using PEP that includes efavirenz, it would be better to stop this medicine and to continue with either: (i) a separate pill just containing tenofovir-DF and emtricitabine, or (ii) to also use a protease inhibitor instead of efavirenz for the last two weeks. In the UK, it has never been recommended to use efavirenz for PEP for this reason. Please take this seriously before taking anymore PEP. It might be that two weeks of PEP is enough and you don’t need the next two weeks, depending on your risk.
hi
i’m a nurse i use my pep drugs for two weeks now apart from other effects i have develop a skin rashes and its all over my body also is itchng i cant take it any more what should i do?
Hi Harriet, Sorry we are not doctors but we give HIV treatment information.
When starting HIV treatment many people have mild side effects that normally go away after a few weeks. But having a rash when starting ARVs – even if it’s PEP – must be looked at by your doctor. Some rashes are mild and go away quickly, but on the other hand another rash can be a more serious reaction.
It’s important you go to see the doctor so that the rash can be examined.
Hi doctor,
Am really concerned with afavirenz as its part of my pep drug. After 12 days of successful PEP without any strong side effect. It has emerged that my skin has become itchy to the extent that I feel like giving up on the course.
Personally am not willing to change the drugs as the doctor advised me coz I feel it might cost me to adopt to it.
Kindly advise me
Hi,
It is important tot let your clinic know about your symptoms, especially because it is causing you pain. They can help you work out if your medication is causing it or something else. It is good to hear that you are doing well otherwise.
I recently took odimune, and my legs are so painful, otherwise it is clearing my skin rashes, getting back my weight, what could be the course of this perhaps?