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Kakande B, Isaacs T, Muloiwa R, et al. Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy. F1000Res. 2015;4:175doi: 10.12688/f1000research.6715.1.
Kakande, B., Isaacs, T., Muloiwa, R., Dlamini, S., & Lehloenya, R. (2015). Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy. F1000Research, 4175. https://doi.org/10.12688/f1000research.6715.1
Kakande, Betty, et al. "Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy." F1000Research vol. 4 (2015): 175. doi: https://doi.org/10.12688/f1000research.6715.1
Kakande B, Isaacs T, Muloiwa R, Dlamini S, Lehloenya R. Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy. F1000Res. 2015 Jun 30;4:175. doi: 10.12688/f1000research.6715.1. eCollection 2015. PMID: 26629333; PMCID: PMC4642844.
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F1000Res. 2015 Jun 30;4:175. doi: 10.12688/f1000research.6715.1. eCollection 2015.

Case Report: Stevens-Johnson syndrome following a single double dosing of nevirapine-containing regimen once in an HIV-infected woman on long-term antiretroviral therapy.

F1000Research

Betty Kakande, Thuraya Isaacs, Rudzani Muloiwa, Sipho Dlamini, Rannakoe Lehloenya

Affiliations

  1. Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, 7700, South Africa.
  2. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, 7700, South Africa.
  3. Division of Infectious Disease and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, 7700, South Africa.

PMID: 26629333 PMCID: PMC4642844 DOI: 10.12688/f1000research.6715.1

Abstract

A 31-year old HIV-infected African woman on nevirapine, tenofovir and lamivudine for more than 4 years presented with an 8-day history of symptoms and signs of Stevens-Johnson syndrome. She was on no other medication. Her viral load was undetectable and she had maintained a CD4 count of between 356 and 387cells/mm (3) in the preceding 2½ years. She missed her antiretrovirals 10 days before the onset of her symptoms and subsequently doubled her daily dose the following day. She had been on no other medication in the preceding 8 weeks. Her ARVs were stopped and she fully re-epithelialized with the exception of the lips, over the following 10 days. She was started on a daily single tablet of Odimune® (a fixed drug combination antiretroviral containing tenofovir, emtricitabine and efavirenz). Nevirapine is the most common offender in cases of antiretroviral-associated SJS in published literature. Lamivudine is very rarely implicated while there are no similar reports with tenofovir.  We concluded that nevirapine was by far the most likely offender in this case. Nevirapine toxicity is associated with high CD4 counts, undetectable viral load and high drug plasma level. We postulate that the sudden increase of the plasma levels of nevirapine in a patient with a high CD4 count and undetectable viral load created a perfect storm for the development of SJS in our patient, who had been on the NVP-containing regimen for many years. Clinicians should be aware that severe adverse drug reactions are dynamic and can occur even when the drug has been in use for a long time.

Keywords: HIV; Stevens-Johnson syndrome; double dose; nevirapine

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