Abstract
Abacavir, a nucleoside reverse transcriptase inhibitor, is useful in first and second line therapy as well as a substitute for Stavudine and Zidovudine for toxicity. Although safe and well tolerated, a life threatening hypersensitivity reaction can occur. The risk for developing this reaction relates to the presence of specific genotypes especially HLA-B*5701.
Highlights
Abacavir (ABC), a nucleoside reverse transcriptase inhibitor (NRTI), combined with lamivudine (3TC), has a better short- and long-term outcome than 3TC combined with zidovudine (ZDV) as first-line HIV therapy.[1,2]
ABC hypersensitivity reaction (HSR) has been reported in adults and children
In a European trial of first-line therapy, where 92 children were initiated on ABC, 4 (4.3%) terminated ABC for adverse reactions, 1 case (1%) being considered an HSR
Summary
ABC HSR has been reported in adults and children. The prevalence in clinical trials varies.[11] In a European trial of first-line therapy, where 92 children were initiated on ABC, 4 (4.3%) terminated ABC for adverse reactions, 1 case (1%) being considered an HSR. HLA-B*5701 alone is highly predictive.[14] Despite these advantages, ABC is rarely used as part of first-line therapy in South Africa owing to cost. In the PREDICT-1 study, where patients with HLAB*5701 did not receive ABC, 3.4% of patients given ABC were diagnosed with HSR but no cases could be confirmed with patch testing (a research tool only).[18]. Prospective screening for HLA-B*5701 in patients and THESOUTHERNAFRICANJOURNALOFHIVMEDICINE december 2009 avoidance of ABC in positive patients is effective in reducing HSR, and this is the standard of care in the First World. It is important to remember that HSR has been reported in patients negative for HLA-B*5701.20 In patients in whom HSR reaction was diagnosed and who subsequently tested negative for HLA-B*5701, ABC remains contraindicated
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