RESEARCH ARTICLE


A Model and Risk Score for Predicting Nevirapine-Associated Rash among HIV-infected Patients: In Settings of Low CD4 Cell Counts and Resource Limitation§



Sasisopin Kiertiburanakul*, 1, Somnuek Sungkanuparph1, Kumthorn Malathum1, Siriorn Watcharananan1, Boonmee Sathapatayavongs1, Angkana Charoenyingwattana2, Surakameth Mahasirimongkol3, Wasun Chantratita4
1 Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
2 Pharmacy Department, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand
3 Department of Medical Sciences, Ministry of Public Health, Foreign Affairs Section, 3rd Floor, Building 1, Nonthaburi 11000, Thailand
4 Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand


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© Kiertiburanakul et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Medicine, Faculty of Medicine Ramathibodi Hospital, 270 Rama VI Rd., Bangkok 10400, Thailand; Tel: 662 201 1922; Fax: 662 201 2232; E-mail: rasal@mahidol.ac.th


Abstract

Background:

Rash is the most common adverse effect associated with nevirapine (NVP). We aimed to develop a model and risk score for predicting NVP-associated rash among HIV-infected patients with low CD4 cell counts.

Methods:

Cross-sectional study was conducted and 383 HIV-infected patients consecutively enrolled in the study.

Results:

Of 222 patients in the training set, 116 (52.2%) were males and median (IQR) age was 35.2 (31.1-42.0) years. Median (IQR) CD4 cell count was 104 (35-225) cells/mm3. Of these, 72 and 150 patients were in “rash” and “no rash” group, respectively. Four factors were independently associated with rash: a history of drug allergy (odds ratio (OR) 4.01, 95% confidence interval (CI), 1.75-9.20, P = 0.001), body weight <55 kg. (OR 2.02, 95% CI, 1.09-3.76, p = 0.026), not receiving slow dose escalation (OR 2.00, 95% CI, 1.06-3.77, p = 0.032), and no concomitant drug(s) (OR 2.48, 95% CI, 1.32-4.64, p = 0.005). Receiver-operator characteristic analysis yielded area under the curve of 71% and the goodness-offit statistics was 6.48 (p = 0.840). The variables were given scores of 14, 7, 7 and 9, respectively. A cutoff >21 points defined the high risk individuals which yielded specificity and positive predictive value of 99% and 69%, respectively, with OR of 3.96 (95% CI, 1.79-8.86, p = 0.001).

Conclusions:

A model and risk score for predicting NVP-associated rash performed well in this study population. It might be useful for predicting the risk of rash before NVP initiation among HIV-infected patients with low CD4 cell counts.

Keywords: HIV, model, nevirapine, prediction, rash, risk factor..