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

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.