Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Management of Medication Toxicity or Intolerance

Rash and Hypersensitivity Reactions

Last Updated: May 22, 2018; Last Reviewed: May 22, 2018


  1. Borras-Blasco J, Navarro-Ruiz A, Borras C, Castera E. Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection. J Antimicrob Chemother. 2008;62(5):879-888. Available at
  2. Davis CM, Shearer WT. Diagnosis and management of HIV drug hypersensitivity. J Allergy Clin Immunol. 2008;121(4):826-832 e825. Available at
  3. Kea C, Puthanakit T, Apornpong T, et al. Incidence and risk factors for nevirapine related toxicities among HIV-infected Asian children randomized to starting ART at different CD4%. Abstract MOPE240. Presented at: 6th International AIDS Society Conference on HIV Pathogenesis and Treatment and Prevention. 2011. Rome, Italy.
  4. Mallal S, Nolan D, Witt C, et al. Association between presence of HLA-B*5701, HLA-DR7, and HLA-DQ3 and hypersensitivity to HIV-1 reverse-transcriptase inhibitor abacavir. Lancet. 2002;359(9308):727-732. Available at
  5. Mallal S, Phillips E, Carosi G, et al. HLA-B*5701 screening for hypersensitivity to abacavir. N Engl J Med. 2008;358(6):568-579. Available at
  6. Mirochnick M, Clarke DF, Dorenbaum A. Nevirapine: pharmacokinetic considerations in children and pregnant women. Clinical Pharmacokinetics. 2000;39(4):281-293. Available at
  7. Puthanakit T, Bunupuradah T, Kosalaraksa P, et al. Prevalence of human leukocyte antigen-B*5701 among HIV-infected children in Thailand and Cambodia: implications for abacavir use. Pediatr Infect Dis J. 2013;32(3):252-253. Available at
  8. Stern JO, Robinson PA, Love J, Lanes S, Imperiale MS, Mayers DL. A comprehensive hepatic safety analysis of nevirapine in different populations of HIV infected patients. J Acquir Immune Defic Syndr. 2003;34 Suppl 1(Suppl 1):S21-33. Available at
  9. Shubber Z, Calmy A, Andrieux-Meyer I, et al. Adverse events associated with nevirapine and efavirenz-based first-line antiretroviral therapy: a systematic review and meta-analysis. AIDS. 2013;27(9):1403-1412. Available at
  10. Tas S, Simonart T. Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update. Dermatology. 2003;206(4):353-356. Available at
  11. Trottier B, Walmsley S, Reynes J, et al. Safety of enfuvirtide in combination with an optimized background of antiretrovirals in treatment-experienced HIV-1-infected adults over 48 weeks. J Acquir Immune Defic Syndr. 2005;40(4):413-421. Available at
  12. Vitezica ZG, Milpied B, Lonjou C, et al. HLA-DRB1*01 associated with cutaneous hypersensitivity induced by nevirapine and efavirenz. AIDS. 2008;22(4):540-541. Available at
  13. Yuan J, Guo S, Hall D, et al. Toxicogenomics of nevirapine-associated cutaneous and hepatic adverse events among populations of African, Asian, and European descent. AIDS. 2011;25(10):1271-1280. Available at
  14. Dziuban EJ, Hughey AB, Stewart DA, et al. Stevens-Johnson syndrome and HIV in children in Swaziland. Pediatr Infect Dis J. 2013;32(12):1354-1358. Available at
  15. Rutstein RM, Samson P, Fenton T, with the PACTG 1020A Study Team. Long-term safety and efficacy of atazanavir-based therapy in HIV-infected infants, children and adolescents: The Pediatric AIDS Clinical Trials Group Protocol 1020A. Pediatr Infect Dis J. 2015;34:162-167.
  16. Perry ME, Almaani N, Desai N, Larbalestier N, Fox J, Chilton D. Raltegravir-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome—implications for clinical practice and patient safety. Int J STD AIDS. 2013;24(8):639-642. Available at
  17. Bourezane Y, Salard D, Hoen B, Vandel S, Drobacheff C, Laurent R. DRESS (drug rash with eosinophilia and systemic symptoms) syndrome associated with nevirapine therapy. Clin Infect Dis. 1998;27(5):1321-1322. Available at
  18. Ripamonti D, Benatti SV, Di Filippo E, Ravasio V, Rizzi M. Drug reaction with eosinophilia and systemic symptoms associated with raltegravir use: case report and review of the literature. AIDS. 2014;28(7):1077-1079. Available at
  19. Noguera-Morel L, Hernandez-Martin A, Torrelo A. Cutaneous drug reactions in the pediatric population. Pediatric Clinics of North America. 2014;61(2):403-426. Available at
  20. Bossi P, Colin D, Bricaire F, Caumes E. Hypersensitivity syndrome associated with efavirenz therapy. Clin Infect Dis. 2000;30(1):227-228. Available at
  21. Darunavir (Prezista) [package insert]. Food and Drug Administration. 2015. Available at,202895s013lbl.pdf. Accessed January 13, 2017.
  22. Emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Complera) [package insert]. Food and Drug Administration. 2015. Available at,202895s013lbl.pdf. Accessed January 20, 2017.
  23. Dolutegravir (Tivicay) [package insert]. Food and Drug Administration. 2015. Available at Accessed January 20, 2017.

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