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Managing the S/E of HIV treatment
Jul 2, 2006

My sister has recently been diagnosed with HIV. Her CD4 count is 189. The protocol in South Africa requires that a patient is started on ART when the CD4 falls below 200. She had recently been started on a regimen of Zidovudine, Lamivudine and Efavirenz. Two weeks into her treatment she has developed erythema multiforme on the extensor surfaces of all her limbs. Two days prior to that, she had nausea and vomited, post-prundially. The nausea and vomiting subsided without any treatment. She was subsequently prescribed Prednisone 20 mg bd, Hydrocortisone creame and an anti-histamine (Receptizone) to manage her Sx. My question to you is, do you continue to prescribe the same ART's or do you take monthly blood results to determine whether the patient is in Lactic acidosis, has developed Hepatitis or bone marrow suppression before changing the drug regimen? Would it be advisable to take a biopsy to determine whether the patient has developed Steven-Johnson syndrome as a result of the use of AZT? Would you also advice that treatment is immediately changed to D4T, 3TC and Efavirenz or should I continue treating the symptoms before changing the drug regimen?

Response from Dr. Henry

Erythema multiforme would generally be more often due to the efavirenz than zidovudine. Often efforts are made to treat through the rashes/skin problems seen with efavirenz,. Nevirapine is not an attractive option as an alternative to efavirenz (usually would consider a protease inhibitor but that might not be available in South Africa. A skin biopsy may provide some guidance. KH



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