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Prevalence aof abacavir-associated hypersenstitivity syndrome and hla-b5701 allele in a portuguese...
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Transcript of Prevalence aof abacavir-associated hypersenstitivity syndrome and hla-b5701 allele in a portuguese...
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.