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 Richard, has the rash now gone? Are you experiencing any other symptoms? If not, there is nothing to suggest that your liver is ‘sensitive’. Do you know why you were given a course of PEP that included efavrienz? Because of the high side effect profile of efavirenz, it is not used in PEP as the body does not have enough time to get used to it and there are more suitable drug combinations to be used as PEP?
It is great that you have tested negative. While it is likely to remain so, a 4th generation test is not completely accurate until 42 days after PEP. 38 days is very suggestive that you will remain negative but it is still possible to test positive. For this reason a second test from 42 days onwards will be able to cofnirm your status.
develop rash (pimples and itching on the hands, back and chest) during and 3 weeks after my pep (efavirenz) course, today 38 post pep my fourth generation hiv result was negative, I have taken every alcohol.. My The doctor says that it is probably that although efavirenz is no longer in my circulation, it left my liver sensitive. What do you think?
Hi Savage, if you have been using the condom correctly there is no risk of contact. HIV cannot pass through condoms. Furthermore, as you have been on PEP for the following 2 exposures this would have afforded further protection against contracting HIV. In this instance there is no risk to you.
Hello Doctor,
Please help. Im so so so worried. I had sex with a guy and he refused to test. So i concluded maybe he was sick or he was just afraid basing on his behaviour of having multiple women. However, we did use protection. I went to the hospital after the incidence of him denying to get tested even though i had used protection becausw the intercourse was so rough and i cant help but think we might have touched each other on areas that were not covered by the condom. I went at about 40 hours, Amidst my pep medication, after twelve days, we had sex again, after he agreed he would test, i found myself agreeing to it again, and we had sex amidst my pep medication, with condom of course. Now, i am almost finish my medication, the 28days course but i have developed sone sort of itching two week after, mostly on my back, chest, rib area, hands, face and alittle on the legs. Im so worried. Someone please tell me the chances i have for contracting HIV.
Hi Fahad, PEP after 72 hours has not been proven to be effective. I understand that there will be a lot of anxiety around your results but remember HIV is not common to catch. It is rare to become positive after one chance exposure. This link might help with your feelings of anxiety around your status: https://i-base.info/guides/testing/hiv-testing-feelings-of-fear-anxiety-and-guilt Unfortunately the tests you have already done are not conclusive. Testing this soon will not be conclusive. You will be able to test 6 weeks after you have finished PEP. Do you know if the guy you slept with was on medication? If so it is likely he was undetectable, meaning he could not pass on HIV. U=U explains this: https://i-base.info/u-equals-u/
Dear All, kindly anyone answer me please I have sex with a guy who was HIV positive. I didn’t know that he was HIV positive and after 48 hours he text me and Show me the rapid test kit result which was HIV positive. and I was so worried because because I didn’t get PEP from the hospital on time. I took my first PEP dose in 78 hours. I am so worried because I don’t know it will be work or not I read that PEP only work within 72 hours & now I completed PEP 28days course. hospital took my blood before starting PEP and said me that it was negative and during PEP I check my self by rapid test kit & it was also negative. now hospital again took my blood but haven’t get result yet. so worried that what will happen..
anyone have have this kind of experience please share your valuable experience and guide me what will i do :(
Hi Anonymous,
It’s possible that the rash is a side effect of the Tribuss, you’ll need to see a doctor about this as you may need to stop taking the Tribuss.
Good day, i was recently exposed to HIV and I’ve been on Tribuss (600mg efavirens) for about 2 weeks now. I tested negative for HIV recently after exposure. I’ve developed mild rash on my arms & back and I would like to know what could be the cause?
Hi Johanna,
Please talk to your doctor about your symptoms. There could be other reasons for the reaction other than your HIV meds.
But please let us know what HIV meds you’re taking. And if you have access to your CD4 count and viral load results, please tell us what they are.
Morning i have been taking one pill for 5 years so this year I have reation what can it be it comes an go please help.