Side Effects of nevirapine: A Synthesis of Findings from 21 Studies

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Original Abstract of the Article

Main Research Findings

Nevirapine is an antiretroviral drug used to treat HIV-infected individuals, but it can cause various side effects. 21 found that the incidence of nevirapine toxicity was significantly higher in children switched from efavirenz to nevirapine, compared to those who started nevirapine-based therapy directly. 14 highlighted the serious skin reactions, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are unpredictable and potentially life-threatening. 13 analyzed adverse drug reaction reports in Nigeria, revealing that patients on antiretrovirals, including nevirapine, are prone to various side effects. 8 reviewed serious adverse drug reaction reports in Nigeria, indicating that nevirapine can lead to severe side effects like liver dysfunction, skin rash, and blood cell abnormalities. 4 explored cutaneous adverse drug reactions among people living with HIV in Malaysia, indicating a high incidence of skin reactions associated with nevirapine.

Reasons for Side Effects

The side effects of nevirapine can be caused by various factors, including the drug's properties, the patient's genetic background, pre-treatment CD4 cell count, gender, and concomitant medications. 11 found that nevirapine is more likely to cause hypersensitivity reactions during the first three months of treatment, especially in patients with high CD4 cell counts. 5 suggests that the side effects are often due to the body's immune response to drug-modified proteins. 7 found that nevirapine's metabolites can bind to histones, potentially altering chromatin structure and contributing to adverse reactions.

Common Side Effects

Skin Rash

Skin rash is a common side effect of nevirapine. 1 reported skin rash in 20.3% of pregnant women taking nevirapine. 8 found skin rash to be the most frequently reported adverse event in Nigeria. 4 analyzed various patterns of skin reactions in people living with HIV in Malaysia. reported a higher likelihood of severe nevirapine rash in women compared to men.

Liver Dysfunction

Nevirapine can cause liver dysfunction. 1 reported liver function abnormalities in 6% of pregnant women taking nevirapine. 8 also found cases of liver dysfunction associated with nevirapine in Nigeria.

Neuropsychiatric Symptoms

Nevirapine can affect the nervous system and cause neuropsychiatric symptoms like headache, dizziness, sleep disturbances, and decreased concentration. explored the discontinuation of efavirenz-based regimens due to neuropsychiatric side effects.

Measures to Counter Side Effects

Skin Rash

If you experience a skin rash, consult a doctor for appropriate treatment. Severe rash might require discontinuing nevirapine. 14 emphasizes the importance of early intervention for serious skin rashes like SJS and TEN.

Liver Dysfunction

If you suspect liver dysfunction, consult a doctor immediately and get blood tests. Discontinuing nevirapine or switching to another medication might be necessary.

Neuropsychiatric Symptoms

If you experience neuropsychiatric symptoms, consult a doctor for appropriate treatment. Adjusting nevirapine dosage or switching to another medication might be necessary.

Comparison between Studies

Commonalities in Studies

Several studies consistently indicate that nevirapine can cause side effects like skin rash, liver dysfunction, and neuropsychiatric symptoms.

Differences in Studies

Research findings differ regarding the frequency of nevirapine side effects and the characteristics of patients more prone to these side effects. For example, 1 reported a 20.3% incidence of nevirapine side effects in pregnant women, while 8 suggests a higher incidence in Nigeria. 11 found that high CD4 cell counts increase the risk of nevirapine side effects, while 1 did not find a clear correlation between CD4 count and side effect incidence. These discrepancies may be due to differences in study populations, research methods, and study periods.

Points to Note regarding Real-Life Application

Nevirapine is an effective treatment for HIV infection, but understanding the risks of side effects is crucial. When taking nevirapine, consult your doctor and choose a treatment plan that is right for you. If you are pregnant or have a decreased liver function, consult your doctor before starting nevirapine. If you experience any side effects, such as skin rash, liver dysfunction, or neuropsychiatric symptoms while taking nevirapine, consult your doctor immediately.

Limitations of Current Research

There are still many unanswered questions about nevirapine. For instance, further research is needed to understand the mechanisms by which nevirapine causes side effects and to develop ways to prevent them. The long-term impact of nevirapine side effects is not fully understood. More research is necessary to gain a better understanding of nevirapine safety.

Future Research Directions

To better understand nevirapine side effects, the following research is needed: ・ Research to elucidate the mechanisms by which nevirapine causes side effects ・ Research to develop methods to prevent nevirapine side effects ・ Research to investigate the long-term effects of nevirapine side effects ・ Research to develop new indicators for assessing the risk of nevirapine side effects

Conclusion

Nevirapine is an effective drug for treating HIV, but it is crucial to be aware of the potential for side effects. Consult with your doctor to discuss your treatment plan and the associated risks. If you experience any side effects, seek medical attention promptly. Further research is ongoing to improve our understanding of nevirapine and develop safer treatment strategies.

Literature analysis of 21 papers
Positive Content
13
Neutral Content
0
Negative Content
8
Article Type
0
0
0
4
20
2.

Risk of side effects associated with the use of nevirapine in treatment-naïve patients, with respect to gender and CD4 cell count.

Author: KnobelH, GuelarA, MonteroM, CarmonaA, LuqueS, BerenguerN, GonzálezA

Toxicity

This study aims to evaluate the effectiveness of nevirapine (NVP) usage recommendations based on CD4 count and gender in preventing side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

3.

Clinical and histopathological aspects of lichenoid dermatitis in patients of retroviral diseases.

Author: TambeSwagata A, ZambareUddhao S, NayakChitra S, PatilPriyanka D, ChhonkarAditi

LP treatment
LP

Lichen planus (LP) is rarely reported in HIV patients, but our case series of 20 patients highlights the possible etiology and challenges in managing LP-like lesions in this population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

The Emerging Role of the Innate Immune Response in Idiosyncratic Drug Reactions.

Author: SernoskieSamantha Christine, JeeAlison, UetrechtJack Paul

Idiosyncratic drug reactions

Idiosyncratic drug reactions (IDRs) are adverse effects that are not predictable from a drug's known pharmacology. This review focuses on the role of the innate immune system in initiating IDRs, suggesting that understanding the early stages of immune activation is crucial for drug development and risk assessment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience.

Author: OumarAboubacar Alassane, DakouoMamadou, TchibozoAnicet, MaigaMamoudou, LandouréGuida, Abdi-BogorehRaysso, TulkensPaul M, DaoSounkalo, YombiJean Cyr

Drug reactions

Antiretroviral therapy (ART) is widely available in sub-Saharan Africa (SSA), but there is limited data on ART-induced adverse drug reactions (ADRs). This study reported the frequency and risk factors of ART-induced ADRs in a Malian population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

10.

Safety of 6-week Neonatal Triple-combination Antiretroviral Postexposure Prophylaxis in High-risk HIV-exposed Infants.

Author: AnugulruengkittSuvaporn, SuntarattiwongPiyarat, OunchanumPradthana, SrirompotongUssanee, JantarabenjakulWatsamon, SophonphanJiratchaya, PunnahitanonSunti, PancharoenChitsanu, CresseyTim R, ChokephaibulkitKulkanya, PuthanakitThanyawee,

Prevent HIV transmission
Adverse events

Zidovudine/lamivudine/nevirapine is safe for neonatal postexposure prophylaxis (PEP) for HIV-exposed infants.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

11.

Nevirapine in HIV maintenance therapy - can "old drugs" survive in current HIV management?

Author: NotterJulia, BregenzerAndrea, VernazzaPietro, KahlertChristian R

Long-term tolerability
Hypersensitivity reactions

This study investigated the use of nevirapine-containing regimens in patients with human immunodeficiency virus (HIV) infection. Although nevirapine is associated with hypersensitivity reactions in the first 3 months of treatment, the study found that the rate of adverse events was lower in patients already on suppressive combined antiretroviral therapy (cART).

Evaluation StudyResearch that systematically evaluates the effectiveness of a particular program or policy. It measures its outcomes and provides important information for future decision-making.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

Is there a need for shifting patients on long term nevirapine based regimens to efavirenz based regimens: a cross-sectional study?

Author: GuptaNitin, MittalAnkit, VinodKutty Sharada, FazalFarhan, KhotWasim, RanjanSanjay, NischalNeeraj, SonejaManish, BiswasAshutosh, WigNaveet, SoodRita

HIV treatment

This cross-sectional study evaluated the need to shift patients from nevirapine-based therapy to efavirenz-based therapy for HIV infection, finding no significant differences in hematological or biochemical derangements, CD4 count, or immunological response.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

An update on HLA alleles associated with adverse drug reactions.

Author: Fricke-GalindoIngrid, LLerenaAdrián, López-LópezMarisol

Adverse drug reactions

Several HLA alleles have been linked to adverse drug reactions (ADRs), particularly those induced by carbamazepine, allopurinol, abacavir and nevirapine.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

Antiretroviral Treatment with Efavirenz Disrupts the Blood-Brain Barrier Integrity and Increases Stroke Severity.

Author: BertrandLuc, DygertLevi, ToborekMichal

HIV treatment
Cerebrovascular complications

This study evaluated the impact of several non-nucleoside reverse transcriptase inhibitors (NNRTI) on the integrity of the blood-brain barrier and their impact on severity of stroke. The study found that Efavirenz, but not other NNRTIs, altered claudin-5 expression, increased endothelial permeability, and disrupted the blood-brain barrier integrity, increasing the severity of stroke in a model of middle cerebral artery occlusion in mice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Stevens-Johnson syndrome and toxic epidermal necrolysis: an update on pharmacogenetics studies in drug-induced severe skin reaction.

Author: RufiniSara, CiccacciCinzia, PolitiCristina, GiardinaEmiliano, NovelliGiuseppe, BorgianiPaola

Adverse reaction prevention
Personalized therapy

This review summarizes recent progresses in the Pharmacogenetics studies related to Stevens-Johnson syndrome/toxic epidermal necrolysis and highlights the use of some of these genomic variants in the clinical practice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

Investigation of Efavirenz Discontinuation in Multi-ethnic Populations of HIV-positive Individuals by Genetic Analysis.

Author: CumminsNathan W, NeuhausJacqueline, ChuHaitao, NeatonJames, WyenChristoph, RockstrohJürgen K, SkiestDaniel J, BoydMark A, KhooSaye, RotgerMargalida, TelentiAmalio, WeinshilboumRichard, BadleyAndrew D,

HIV treatment
Neuropsychiatric side effect

Efavirenz-based antiretroviral therapy is expanding globally. However, discontinuation due to neuropsychiatric side effects is common, particularly among Black patients, leading to premature drug discontinuation and considerable morbidity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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