Prevalence of abacavir-associated hypersenstitivity syndrome and HLA-B5701 allele in a Portuguese HIV population
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Santos N, Pinheiro C, Carolino F, Faustino AS, Soares P, Sarmento A, Rodrigues-Cernadas J. Prevalence of abacavir-associated hypersensitivity syndrome and HLA-B*5701 allele in a Portuguese HIV population. Allergy 2013;68(Suppl.97):517-518.
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Prevalence of abacavir-associated hypersenstitivity syndrome and HLA-B5701 allele in a Portuguese HIV population
- 1. The prevalence of HLA-B*5701 and of suspected reactions prior to screening were in accordance to the described for the European population Most suspected ABC-HS reactions were either rash or fever and none required hospitalization We were able to exclude an association between abacavir/HLA-B*5701 and the presented reaction in 2 patients The relevance of patch tests in these patients could not be fully evaluated due to missing data No ABC-HS occurred since January 2008, when HLA-B*5701 screening was implemented Natacha Santos1, Carmela Pinheiro2, Fabrícia Carolino1, Ana Sofia Faustino2, Pedro Soares3, António Sarmento2, Josefina Rodrigues Cernadas1 1Immunoallergology Department, Centro Hospitalar Sao Joao, E.P.E., Porto, Portugal. 2Infecciology Department, Centro Hospitalar Sao Joao, E.P.E., Porto, Portugal. 3Pharmacy Department , Centro Hospitalar Sao Joao, E.P.E., Porto, Portugal Abacavir is an antiretroviral drug used as first line treatment for HIV infection. Of treated patients, 5-8% develop an abacavir-associated hypersensitivity syndrome (ABC-HS) in the first 6 weeks, which can be life-threatening. ABC-HS has been strongly associated with the presence of the HLA- B*5701 allele. Screening for this allele is recommended for all patients prior to beginning therapy with abacavir since it virtually eliminates all immunologically confirmed ABC-HS. Aims: • To determine the prevalence of HLA-B*5701 in the adult HIV population followed in our hospital • To characterize and confirm suspected ABC-HS Clinical data on patients under abacavir treatment since January 2006 was analyzed to search for symptoms of ABC-HS. HLA-B*5701 screening was performed by real time PCR in all patients since January 2008 and those with positive HLA-B*5701 began HIV treatment with an alternative drug. Reactions of suspected ABC-HS were characterized. HLA-B*5701 and patch tests (1% and 10% abacavir in petrolatum) with readings at 48 hours, were performed in patients with suspected ABC-HS without previous testing. In relation to this presentation, I declare that there are no conflicts of interest January 2008 to December 2012 573 patients screened 35 (6.1%) HLA-B*5701 positive No suspected ABC-HS January 2006 to December 2007 186 patients began abacavir 7 (4.3%) with suspected ABC-HS Gender Age at reaction (years) Median=45 Time of onset (days) Median=7 Clinical manifestations HLA-B*5701 Patch tests male 35 3 Liver enzymes elevation Negative Negative female 36 7 Non pruritic rash and myalgia Positive n.p.§ male 63 1 Sensation of dyspnea and throat swelling n.p.¤ n.p.¤ male 45 13 Fever, pruritus, malaise and liver enzymes elevation Positive Positive male 59 4 Fever, rash, myalgia and liver enzymes elevation n.p.¥ Positive female 51 10 Fever and malaise Negative Negative male 27 12 Pruritic rash in the trunk Positive Negative Figures 1 and 2. Abacavir 1% and 10% patch tests positive for the 10% concentration n.p. not performed. § unable to commute to hospital to perform patch tests. ¤ unreachable. ¥ HLA-B*5701 testing ongoing Data unavailable in 23 patients Two patients were treated with oral corticosteroids. None required hospitalization.