PI Perspective 31: Nevirapine, Prednisone and Rash

Important note: Information in this article was accurate in October 2000. The state of the art may have changed since the publication date.

Nevirapine, Prednisone and Rash

Project Inform Perspectives 31 - October, 2000

Findings from a recent study show that people taking prednisone with nevirapine (Viramune) were more likely to develop nevirapine-related rash compared to people not taking prednisone. Prednisone is commonly used to treat rash, a potentially harmful side effect of nevirapine. Researchers theorized that pre-treating people with prednisone might minimize rash. This contrary finding is different from reported anecdotes of experiences in the community.

The six-week study included 138 people. About half took the standard course of nevirapine (two weeks of 200mg nevirapine once a day and then 200mg twice a day), and the other half received the standard course of nevirapine with prednisone.

Of those taking nevirapine alone, 19% developed rash compared to 36% of those taking prednisone and nevirapine. Surprisingly, there was little difference in the incidence of rash between the two groups in people who had not taken anti-HIV therapies. There was a big difference among people who had previously taken anti-HIV therapies (18% vs. 43%). Furthermore, there were more reports of serious rash among people taking prednisone.

There were no differences in change in viral loads or CD4+ cell counts at the end of the study between the two groups.

This study serves as an important warning that anecdotal reports may not always be reliable and what sounds logical sometimes turns out not to be. It seemed perfectly reasonable to expect that prednisone would reduce the incidence of rash, but in fact it appeared to make things worse. Moreover, the study suggests that the risk of developing nevirapine-related rash increases among people who have previously used anti-HIV therapy before compared to those starting nevirapine as part of their first regimen. While certainly everyone should be aware of and monitor for this side effect when starting a regimen with nevirapine, people currently using anti-HIV therapy but starting a new regimen with nevirapine should be particularly aware of the increased risk. Anecdotal reports also claim that another drug, Benadryl, is effective in reducing the likelihood of developing nevirapine-associated rash. It remains to be seen whether this belief holds up in a study.

Viral Load Blips
Many people taking anti-HIV therapies are able to reduce their viral loads to below the limits of detection on the currently approved tests. However, many also experience an occasional viral load `blip', where viral load briefly becomes detectable and then falls back below the limit of detection. The significance of the blips was not known, but physicians often feared that they might be early signs of impending viral resistance and drug failure. Several reports at the International AIDS Conference, however, came to the conclusion that an occasional blip has little or no impact on the long-term control of viral load.

One study followed 241 people who had received AZT + 3TC + indinavir (Crixivan) for about one and a half years. During that period, 97 people had at least one viral load blip (between 50 and 200 copies HIV RNA); of these, 24 had two blips. The study found no relationship between the blips and later failure to control viral load, which for this study was defined as two consecutive viral loads above 200 copies HIV RNA. Nine out of the 97 people (9.3%) with blips and twenty out of the 144 people (13.9%) without blips had increasing viral loads during the follow-up period. Statistically, there was no difference in the rate of drug failure between those who did and did not experience the blips.

001001
PI001004

©2000. This document is copyrighted by Project Inform, 205 13th Street, #2001, San Francisco, CA 94103. Treatment Hotline: 800-822-7422 (toll-free) or 415-558-9051 (in the San Francisco Bay Area and internationally) All Project Inform materials may be reprinted and/or distributed without prior permission. However, reprints may not be edited and must include the following text: "From Project Inform, for more information contact the Project Inform National HIV/AIDS Treatment Hotline, 800-822-7422." For permission to edit any Project Inform material for further publication, contact David Evans at the Project Inform office.

AEGiS is made possible through unrestricted grants from Roxane Laboratories, Inc., iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1985, 2000. AEGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS and the Sisters of Saint. Elizabeth of Hungary, or the party credited as the provider of the content.