Abacavir-induced reaction with fever and severe skin rash in a patient tested human leukocyte antigen-B*5701 negative

Abstract

The most serious adverse event caused by abacavir is the hypersensitivity reaction, which is usually associated with the presence of the human leukocyte antigen (HLA) subtype B*5701, as shown in recent studies. We describe the case of a 41-year-old Caucasian female patient, who tested HLA-B*5701 negative and developed fever and severe skin rash 10 weeks after the start of abacavir therapy. Similar reports suggest that not all severe abacavir-induced adverse events occur as a result of classic hypersensitivity reactions, and can present also in HLA-B*5701-negative patients.

Kidney failure during HIV disease treated with tenofovir, multiple concurrent diseases and drug therapies

“…• our patient already experienced an allergic reaction to efavirenz, and we are aware that some hypersensitivity reactions to abacavir may occur also in the absence of the specific genotyping testing [71,72]; • moreover, abacavir administration has been linked in some studies (but it led to a fierce, endless discussion according to other data, which primed the so-called endless "abacavir saga") [122,123] to an overall increased, global cardiovascular risk [119,120], so that it was "probably" to avoid in our patient, who suffered of a recent acute heart infarction, even though the two available fixed dose combinations tenofovir-emtricitabine and abacavir-lamivudine, proved a similar virological activity in both antiretroviral naïve and experienced patients [47,82,87,132,133], although patients on a tenofovir-versus abacavir-containing regimen showed an increased risk of kidney dysfunction, as recently underlined in the "ASSERT" study, which addressed just serum hypophosphoremia as a serious "clue" of an incipient renal toxicity in patients taking tenofoviremtricitabine, as opposed to those treated with abacavir-lamivudine, with all enrolled patients taking efavirenz as the "third" drug of their cART regimen [87].…”

“…cigarette smoking, illicit or recreational drugs use, alcohol intake, lack of an appropriate diet and physical exercise, i.e. a broad series of "unmodifiable" and "modifiable" risk factors for cardiocerebrovascular damage and other potentially severe end-organ disorders among HIV-infected patients, as known since many years [8,10,61,[66][67][68]; • the progressively increased mean age of the entire population living with HIV, which unavoidably predisposes to further comorbidities and to an exponential increase of nested disorders, as well as the expected cumbersome problems linked to their prevention, monitoring, and management in the daily clinical practice of physicians engaged in the care of people affected by HIV disease, even more during the third millennium [4,5,7,8,10,18,[19][20][21][22]27,28,[34][35][36][41][42][43]61,69,70]; • the genetic background of patients, taken as racial-and gender-related issues, and individual features, which may influence and affect all the above-mentioned causes and correlations [10,18,21,22,[70][71][72][73][74][75].…”

Pacientes con infección por VIH/SIDA en una Unidad de Pacientes Críticos: La experiencia de un hospital general en un país en desarrollo

“…La probabilidad de desarrollar estas reacciones ante abacabir en pacientes que no portan el alelo HLA B*5701 es muy baja y por precaución se recomienda efectuar el análisis genómico antes de iniciar su uso 28 . No obstante, se han descrito algunos casos de reacciones graves por hipersensibilidad en pacientes HLA B*5701 negativos, incluso en las primeras horas 29 . Existe también la posibilidad de que esta anafilaxia pueda estar asociada a lamivudina 30 .…”

Hypersensitivity reactions to HIV therapy

“…Even a negative patch and HLA-B*5701 test should not be used as ground for rechallenge in a patient who has experienced a clinical syndrome in keeping with ABC hypersensitivity [121][122][123]. Desensitization is unstudied and, although useful for sulphonamide hypersensitivity, may be inappropriate for antiretroviral hypersensitivity, since it would necessitate a period of subtherapeutic drug concentrations leading to the development of drug resistance.…”