CD4 cell counts level and risks of Cutaneous Adverse Drug Reactions in HIV-infected patients receiving standard anti-tuberculosis drugs in Thailand

Abstract

Objectives: Tuberculosis is the major cause of morbidity and mortality in HIV-infected patients. Anti-tuberculosis drugs can cause cutaneous adverse drug reactions (CADRs). This study was conducted to evaluate the difference in CADRs incidence between low and high CD4 cell count and to identify other CADRs risk factors in HIV/TB co-infected patients. Methods: We collected a retrospective cohort of adult HIV/tuberculosis co-infected patients receiving a standard anti-tuberculosis regimens between 1 Jan 2008 – 31 Dec 2015 at Vajira hospital, Thailand. Baseline demographic, clinical characteristics and factors associated with CADRs included CD4 cell count status were collected. Results: Of 307 patients enrolled, CADRs were found in 48 patients during six months period of tuberculosis treatment (Incidence rate = 0.41 events/person-year). Maculopapular rash was the most prevalent CADRs. Low CD4 cell count are not the risk of CADRs. Cox regression analysis revealed a moderate decrease in GFR, history of drug hypersensitivity and concomitant Co-trimoxazole use were all associated with CADRs. Concomitant antiretroviral use was associated with lower risk of CADRs. However, the analysis revealed no different in the time to CADRs between patients with lower and higher CD4 cell count. Conclusions: CADRs are common in HIV/TB co-infected patients. Early recognition and prompt withdrawal of suspected agent could prevent complications and improve tuberculosis care.