Genome-wide association study identifies variations in 6p21.3 associated with nevirapine-induced rash

Clin Infect Dis. 2011 Aug;53(4):341-8. doi: 10.1093/cid/cir403.


Background: We aimed to identify disease-predisposing variations with nevirapine-induced rash using genome-wide single-nucleotide polymorphisms (SNPs) as genetic markers.

Methods: A genome-wide association study (GWAS) was performed using ∼550000 markers in 72 human immunodeficiency virus (HIV)-infected Thai patients with nevirapine-induced rash and 77 nevirapine-tolerant patients, and then candidate SNPs were further evaluated in a replication set (88 patients with nevirapine-induced rash and 145 nevirapine-tolerant patients).

Results: The genome-wide association analysis and replication studies of candidate SNPs identified significant associations of nevirapine-induced rash with 2 SNPs (rs1265112 and rs746647) within CCHCR1 on chromosome 6p21.3 (P(GWAS) = 1.6 × 10(-4); P(replication) = 2.6 × 10(-5); P(combined) = 1.2 × 10(-8)). The odds ratio (OR) of the risk genotypes under a dominant model was 4.36 (95% confidence interval [CI], 2.58-7.36). The noncoding SNPs rs1265112 and rs746647 were in complete linkage disequilibrium with the nonsynonymous SNP rs1576 (r(2) = 1.00), which has been associated with psoriasis. The logistic regression analysis also indicated genetic variations in CCHCR1 to be significantly associated with rash, with an OR of 2.59 (95% CI, 1.82-3.68; P = .007). The receiver operating characteristic curve showed that the algorithm had an area under the curve of 76.4%, which was developed with 5 factors: rs1576*G status, HLA-B*3505 status, not receiving prescribed lead-in of nevirapine, history of drug allergy, and CD4 cell count prior to the nevirapine treatment.

Conclusions: We demonstrated that genetic variations in CCHCR1 are strongly associated with nevirapine-induced rash. A predictive model that includes genetic and clinical risk factors for nevirapine-associated rash might be useful in lowering the incidence of rash associated with nevirapine initiation among HIV-infected patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Chromosomes, Human, Pair 6*
  • Drug Eruptions / etiology
  • Drug Eruptions / genetics*
  • Genetic Predisposition to Disease
  • Genome-Wide Association Study / methods*
  • HIV Infections / drug therapy
  • Humans
  • Intracellular Signaling Peptides and Proteins / genetics
  • Lamivudine / therapeutic use
  • Logistic Models
  • Nevirapine / adverse effects*
  • Nevirapine / therapeutic use
  • Polymorphism, Single Nucleotide
  • ROC Curve
  • Retrospective Studies
  • Risk Factors
  • Stavudine / therapeutic use
  • Thailand


  • Anti-HIV Agents
  • CCHCR1 protein, human
  • Intracellular Signaling Peptides and Proteins
  • stavudine, lamivudine, nevirapine drug combination
  • Lamivudine
  • Nevirapine
  • Stavudine