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StevensJohnson Syndrome and HIV in Children in Swaziland

Dziuban, Eric J. MD*†‡; Hughey, Allison B. BS*; Stewart, David A. MD*; Blank, Douglas A. MD*†‡; Kochelani, Duncan MS*‡; Draper, Heather R. MS*†; Schutze, Gordon E. MD*†‡

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31829ec8e5
HIV Reports

Background: Stevens–Johnson syndrome (SJS) can be a severe and life-threatening reaction with many potential causes, including multiple medications used in HIV care and treatment. Specific risk factors, especially in children, are not currently well-understood.

Methods: We describe a series of cases of SJS that occurred from 2006 to 2010 in an HIV-focused clinic in Mbabane, Swaziland. The electronic medical and pharmacy records of all pediatric patients <20 years old were reviewed to identify cases of SJS. Patient demographic, immunosuppression and outcome data were also collected.

Results: A total of 19 cases of SJS were documented. Eighty-four percent of cases were attributed to nevirapine (NVP) exposure whereas the remaining cases were caused by cotrimoxazole (11%) and efavirenz (5%). Median symptom onset was 22 days after initiation of the offending medication (interquartile range = 14–25 days). At time of SJS, 84% had advanced or severe immunosuppression. Forty-two percent of patients required hospitalization, and no SJS-associated deaths were known to occur. Use of efavirenz was attempted in 8 NVP-associated cases after SJS resolution and was successful in all except 1.

Conclusions: SJS occurrence was rare in this population, with the majority of cases being associated with NVP. All occurred within 32 days of medication initiation, providing a target window for intensified monitoring and anticipatory guidance. SJS can occur in children at any age, with any level of immunosuppression, and can occur during the lead-in dosing period of NVP.

Author Information

From the *Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital; Department of Pediatric, Baylor College of Medicine, Houston, TX; and Baylor College of Medicine-Bristol-Myers Squibb Children’s Clinical Center of Excellence, Swaziland.

Accepted for publication May 8, 2013.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Eric J. Dziuban, MD, Baylor International Pediatric AIDS Initiative, 1102 Bates St. FC-630, Houston, TX 77030. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.