Possible allergic cross-reaction to didanosine and tenofovir in an HIV-1-infected woman.

摘要

A 25-year-old woman tested positive for HIV-1 during a screening blood test. Her CD4 cell count was 234 cells/ [xl (14%) and 311 cells/pi (14%) in two consecutive controls a few weeks apart, whereas HIV R.NA was 56 822 copies/ml and 34 000 copies/ml, respectively. The baseline genotype showed the absence of resistance mutations and she started a once-a-day regimen including tenofovir plus emtricitabine and efavirenz. After 10 days she developed a diffuse rash "with fever and glossitis. Efavirenz was discontinued but her clinical conditions worsened over the following 3 days, so both tenofovir and emtricitabine were stopped, with a dramatic resolution of symptoms within 24 h. After 10 days the patient was restarted on a completely different regimen of zidovudine plus didanosine and ritonavir-boosted fos-amprenavir as both efavirenz and tenofovir might have played a role in the allergic reaction and the patient was distressed over the event.