Risk Factors of Nevirapine Hypersensitivity Reaction among Human Immunodeficiency Virus-1 Infected Treatment Naïve Patients at Korle-Bu Teaching Hospital

Abstract

Objective: Ghana like most African countries, still carry the communicable disease burden. The introduction of antiretroviral drugs in Ghana has improved survival rates amongst HIV patients. According to the National Guidelines for antiretroviral treatment in Ghana, administration of nevirapine, a frontline antiretroviral drug leads to hypersensitivity reactions in some patients. This study examines the clinical risk factors and specific genotypic alleles associated with nevirapine hypersensitivity reactions. Methods: Seventy (70) antiretroviral naive HIV patients, initiating nevirapine-based HAART therapy were enrolled in this cohort study and monitored clinically over a period of 24 weeks from July 2013 through to June 2014. Blood samples were evaluated for aminotransferase activity and DNA genotyped for specific ABCB1 and CYP2B6 markers. Results: Eleven (15.7%) patients were identified as cases and 59 (84.3%) patients classed as comparisons out of the study population at the end of the 24 week-monitoring periods. Eight out of the observed cases were categorized as nevirapine hypersensitivity rash and 4 as hepatotoxicity. The concentration of AST was much higher in the cases (119.44 ± 155.86) compared to the comparisons group (68.80 ± 42.65), p=0.056. The Concentration of ALT was also higher in the cases (136.44 ± 165.99) compared to the control (56.72 ± 33.02) p=0.003. The CYP2B6 516 G>T, variant allele frequency observed in the study was 62 (44.3%). However, there was no variant allele detected for the three SNPs in ABCB1 gene genotyped. Conclusion: The observed NVP HSR outcome suggests an adverse reaction among the cohort of HIV-1 infected patients within the Ghanaian population studied. The effect of this outcome although not statistically significant, might be clinically traced to non-adherence to medication and hospitalization of patients which seem to be a major factor to treatment failure in resource-limited countries.