Factors associated with penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis

People with HIV (PWH) are more susceptible to drug reactions than the general population. This study aimed to investigate the prevalence of, and demographic characteristics associated with a history of penicillin and sulfonamide allergy and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and to assess whether HLA-B*57:01 is associated with these drug reactions among PWH followed in a large French multicenter cohort.

All PWH followed from January 2000 to December 2023 with available results for HLA-B*57:01 were included. Logistic regression models were used to identify associations between each drug allergy (outcome variable) and explanatory variables.

Among 35 924 PWH, the prevalence of penicillin and sulfonamide allergy and SJS/TEN were 1.05% [95% confidence interval (CI) 0.94-1.16], 1.01% (95% CI 0.91-1.11) and 0.15% (95% CI 0.11-0.19), respectively. AIDS status was significantly associated with a higher risk of penicillin and sulfonamide allergy and SJS/TEN; while female sex was associated with sulfonamide allergy and SJS/TEN. Being born in mainland France, other European countries, and North Africa was associated with a higher risk of penicillin allergy [odds ratio (OR) 1.88 [95% CI 1.13-3.42], P  = 0.02], while being born in sub-Saharan Africa was associated with a lower risk of penicillin allergy (OR 0.39 [95% CI 0.19-0.81], P  = 0.009) and sulfonamide allergy (OR 0.57 [95% CI 0.34-0.95], P  = 0.03). The association between HLA-B*57:01 and penicillin allergy was positive but statistically nonsignificant (OR 1.34 [95% CI 0.87-1.97], P  = 0.16).

In the combined antiretroviral therapy era, the prevalence of both penicillin and sulfonamide allergy is low. Our study confirms ethnic differences in penicillin and sulfonamide allergy.