Fact Sheets on Antiretroviral Drugs

Adverse effect
Severe rash/Stevens-
Johnson syndrome
(SJS)
Possible offending
drug(s)
Clinical signs /
symptoms
cough, dyspnea (with or
without rash). While
these symptoms overlap
those of common
infectious illnesses, the
combination of acute
onset of both
respiratory and
gastrointestinal
symptoms after starting
ABC is more typical of a
hypersensitivity
reaction.
NVP: Systemic
symptoms of fever
myalgia, arthralgia,
hepatitis, eosinophilia
with or without rash.
NNRTIs: NVP, EFV Rash usually occurs
during the first 2-4
weeks of treatment.
The rash is usually
erythematous,
maculopapular,
confluent, most
prominent on the
body and arms, may
be pruritic and can
occur with or without
fever. Life-threatening
Stevens-Johnson
Syndrome or toxic
epidermal necrolysis
(SJS/TEN) has been
reported in ~0.3% of
infected individuals
receiving NVP.
<strong>Fact</strong> <strong>Sheets</strong> on Antiretroviral Drugs
Management
be fatal. Administer
supportive therapy.
Do not rechallenge
with ABC (or NVP), as
anaphylactic reactions
and death have been
reported.
Once symptoms
resolve, restart ARVs
with change to
different NRTI if ABCassociated
or to a PI-
or NRTI-based
regimen if NVPassociated.
Discontinue all ARVs.
Permanently
discontinue NVP for
rash with systemic
symptoms such as
fever, severe rash with
mucosal lesions or
urticaria, or SJS/TEN;
once resolved, switch
ART regimen to
different ARV class (e.g.,
3 NRTIs or 2 NRTIs and
PI). If rash is moderate
but not severe and
without mucosal or
systemic symptoms,
change in NNRTI (e.g.,
NVP to EFV) could be
considered after rash
resolves.
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