Protease inhibitors

Protease inhibitors as a class are not associated with hypersensitivity. However, amprenavir (Agenerase), fosamprenavir (Telzir), and tipranavir (Aptivus) have some structural similarity to sulfonamide drugs, which commonly provoke hypersensitivity.

The incidence of rash varied widely amongst patients taking amprenavir in clinical trials, ranging from 3% to about 40%.1 2 3 Rash was uncommon in fosamprenavir trials.

In clinical trials, about 10% of patients taking ritonavir (Norvir)-boosted tipranavir developed a hive-like rash, in some cases accompanied by itching and throat tightness. The risk was higher among women, and in one early study, one-third of HIV-negative women taking oral contraceptives developed a rash with tipranavir. However, in a large phase III trial, rash occurred at similar rates in the tipranavir and control arms.4

References

  1. Goodgame JC et al. Amprenavir in combination with lamivudine and zidovudine versus lamivudine and zidovudine alone in HIV-1-infected antiretroviral-naive adults. Antivir Ther 5: 215-225, 2000
  2. Pedneault L et al. Safety profile and tolerability of amprenavir in the treatment of adult and pediatric patients with HIV infection. Clin Ther 22: 1378-1394, 2000
  3. Haubrich R et al. A phase II safety and efficacy study of amprenavir in combination with zidovudine and lamivudine in HIV-infected patients with limited antiretroviral experience. Amprenavir PROAB2002 Study Team. AIDS 13: 2411-2420, 1999
  4. Cooper D et al. 24-week RESIST study analyses: the efficacy of tipranavir / ritonavir is superior to lopinavir / ritonavir, and the TPV / r treatment response is enhanced by inclusion of genotypically active antiretrovirals in the optimized background regimen. Twelfth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 560, 2005
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