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 Zhnhle,
What type of HIV test did you do? When you were tested positive, did the clinic do a CD4 count test and a viral load test? If they did what were the results?
Hi I got tested positive in the clinic then I was given arvs then develop a rash I went to the doctor I got tested again I was negative and he said I should stop taking my meds mi safe?
Hi Zvisi,
Please see your doctor about the rash. It’s important to check that you’re not having a reaction to your PEP.
What meds are in your PEP? If this is a reaction you can ask to switch to different meds.
But the good news is that as your partner is undetectable the risk to you is zero if they’re taking HIV medication. So you don’t have to take PEP. Please ask your doctor if you need to take PEP too.
Hie .please help I’ve had unprotected sex with my undetectable viral load partner and took pep within 72 hours .im experiencing rash on my face ,chest,back and palms and it’s a bit itch .are they just reactions to the drug or there’s more to it?
Hi Cherish 2,
What drugs are in your PEP? Does it include efavirenz? As it says on the Q&A above efavirenz must be discontinued in patients developing severe rash associated with blistering, desquamation, mucosal involvement or fever.
Please can you go to see the doctor about the blisters. It’s important to ask if the blisters are a side effect of the PEP you are taking.
Hi
On my 27th day of pep I notice fever blisters all over my mouth .
Those that means the pep didn’t work ?
Hi Jackson.
This is something that you should discuss with your doctor as the rash could be due to a number of things.
Hi,
On day 2 after I finished pep treatment, I’m starting to have red rashes and itchy skin all around my body which looks like an allergy to something. Is it after effects of pep or delay Ars?
Thank you.
Hi Eddy,
It’s good that you started PEP within 48 hours and that you had no side effects.
But please see the doctor about your rash and other symptoms. You can tell them that you’ve finished a course of PEP and let them know what drugs were in it.
Hello,
I had a single exposure due to a bursted condom and the state of female partner is unknown. I took pep less than 48hrs and efavirenz/lamivudine and tenofovir combination was what I used. During my pep I had no side effect except on the very first day. I finished pep on the 16th of December 2018 and had a test on the 18th of December 2018 which read negative.
I am really scared because immediately after the 16th, I started having headaches and a little fever.
Then came hallucinations and depression. I noticed two red rashes on my chest.
Please what is your candid advice. Do I really have to worry?