A high incidence of
rash has been reported in HIV-1 patients who received the anti-retroviral
drug nevirapine. In addition, several studies have suggested that polymorphisms of
human leukocyte antigen (HLA) genes may play important roles in
nevirapine-induced
rash. The aim of the present study was to evaluate the effects of different
HLA-C alleles on
rash associated with
nevirapine in patients who started highly active anti-retroviral
therapy (
HAART) containing
nevirapine in Thailand.
RESULTS: A case-control study was carried out involving HIV-1 patients under treatment at Bamrasnaradura
Infectious Diseases Institute, Nonthaburi, Thailand between March 2007 and March 2008. The study included all HIV/
AIDS patients being treated with
nevirapine-containing regimens. The study population comprised 287 HIV/
AIDS patients of whom 248 were
nevirapine-tolerant and 39 developed
rash after
nevirapine treatment. From the
nevirapine-tolerant patients, 60 were selected as the control group on the basis of age, sex, and
therapy history matched for
nevirapine-induced
rash cases. We observed significantly more HLA-Cw*04 alleles in
nevirapine-induced
rash cases than in
nevirapine-tolerant group, with frequencies of 20.51% and 7.50%, respectively (P = 0.009). There were no significant differences between the
rash and tolerant groups for other
HLA-C alleles except for HLA-Cw*03 (P = 0.015).
CONCLUSION: This study suggests that HLA-Cw*04 is associated with
rash in
nevirapine treated Thais. Future screening of patients' HLA may reduce the number of
nevirapine-induced
rash cases, and patients with alleles associated with
nevirapine-induced
rash should be started on anti-retroviral
therapy without
nevirapine.