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 Anon, please realise we are not doctors – just an information service. Please also see this link which has detailed info about PEP, including answers to thyou questions.
https://i-base.info/qa/factsheets/pep-faq
Hello doctor,I had uprotected sex with an infected person,I started pep in 48 hours, after two weeks of starting it now my body is itching and sometimes feel lil pain in my knees and little fever when um in the sun ,but sleeping well at night, could this be because um infected or what?
Hi Anon, please see this info on PEP that answers your questions.
https://i-base.info/qa/factsheets/pep-faq
Started pep almost 24 hours after a possible exposure..was nauseous about a day after starting, kept getting chills & then feeling feverish..that went away then about a week later I got a rash on my hip that still hasn’t gone away..stomach cramps about a week after that & on my last week bumps all over but mainly my back & arms..is it likely that I’m positive for the virus???
Hi Ben, please see here: https://i-base.info/qa/factsheets/pep-faq
Hi doctor, i do unsafe sex with affected girl, I use pep but am filling rashes in my back, an arms, what does it mean
Hi Best, you are not at risk of HIV. Touching dried blood with a healed cut does not risk HIV transmission. As you used a condom there is also no risk from this also. You do not need to be on PEP. Please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hello, please I had condom protected sex with a female that I don’t know her HIV status, during the sex there was a little thick blood stain on my bed that I mistakenly used my hand to touch and rub on my fingers but there was a little cut on d side of my finger that was almost completely healed which I am not sure of if the blood touched and I decided to start PEP within the 48 hours ( the PEP drug is ACRIPTEGA ) 23 days of my pep course I developed few little red rash on the top on my hands and few rash on my neck which is making me worried. I have 5 days to complete my PEP meds please are these rashes caused due reactions to the pep drugs I am taking or due to HIV seroconversion? I can’t have an HIV test now due to the pep pill because I read my test results can only be accurate and conclusive after 6 weeks of pep completion and my anxieties are high now and I will be really hard for me to stay till 6 weeks before confirming my status. Pls from my explanation is there anything you can tell me why I am having the rashes
Hi Anonymous, please follow this link for more information: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hie doctor
I had an unprotected sexual encounter about a month ago and I started my PEP (TLD) pills in less than 24 hrs after the encounter. On day 10, experienced bloated stomach and diarrhea and itchiness. I was prescribed some pills allergex included to help with that and they did. However after I started noticing small pimples appearing on my face that looks like a heat rash and some sort of black maps here and there. Also on my chest too. There are also some black pimples that looks like blackheads but nothing is coming out of them.
In about 2 weeks or so after the encounter with this girl, I got her to get tested and it came out negative and she said her last unprotected sexual encounter was a month ago. So I’m freaking out and my question is what are my chances of being HIV positive. I did and ELISA test and I’m awaiting results but I’m soo freaked l can’t focus. Please assist