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 Sam,
I’m sorry to hear about your recent diagnosis.
However, it’s important that you see your doctors again. That’s because having a very severe allergic reaction means you must change your ART to other HIV meds. Please ask the doctors to look at your rash again and talk to you about switching your HIV meds.
Hello, i am 34 years man from India. Two months ago i was diagnosed positive and after 4 weeks on Tenofovir Dioproxil Fumarte, Lamivudine and Efavirenz, i have developed severe radhes all over my body and palms. The skin feels hot, places its like boils that look like prickly heat and places its red and patchy all which is extremely itchy. I went to the ART center and was told this is normal and sent back with cetrazun which never helped. I went to another doctor who gave me some injection and said this is very severe allergy and asked me to continue my ART and said it will take a while for the body to accept the ART. Is this normal. Meanwhile i still have the rashes and i am pretty sleep deprived.
Hi Derick,
What does the doctor say about your rashes? Please ask your doctor to look at them to make sure they are not a serious reaction to efavirenz.
If the rashes are a side effect you can ask to switch to other HIV meds that can be easier for you to take.
Hi,
First day appointment, doctor got my cd4 – 433, I was started my efavirenz on mid of september and i get little red mark in few part of body. Starting my arm first and the rashes can be spread different part of body in a day. Its faded after 2 weeks . And today few red rashes begin again. I am worry about this will cause my cd4 drop and viraload is increase. My doctor start will get viraload test for me next March 2020.
Hi Mathews,
People often get side effects when they start HIV meds or PEP. But these are usually mild and go away in the first week or two.
Please talk to your doctor about the symptoms. If you have a rash it’s important to ask the doctor to look at it.
This is my third week taking PEP on dis week I feel itching in my back and in my toes what should be the reason is this one of the side effect
Hi Joshua,
It’s a good idea to go to the doctor and show them the rashes. That’s because if this is happening 2 months after finishing PEP, it’s important to find out what’s causing it.
Im experiencing rashes and it is itching 2months after taking pep what could be the problem
Hi Jun,
It’s important that you see the doctor and have them look at your rash.
With some drugs, if you develop a rash during the first few weeks of treatment you must report this immediately to your doctor. This is because it can sometimes lead to very serious reactions.
Hi,
I had been taking my ARVs for the past week, only on my 9th/10th day that I had rashes. I had red marks on several parts of my body particular my arms, neck to upper chest, also noticed rashes are developing in my leg area. No blisters, just pure red markings and controllable itch. Is this normal?