Abacavir hypersensitivity reaction in primary HIV infection.

Abstract

OBJECTIVE:

To evaluate risk factors associated with the abacavir hypersensitivity reaction during primary HIV infection (PHI).

DESIGN:

Acute HIV Infection and Early Disease Research Program protocol (AIEDRP) AI-02-001 provided antiretroviral therapy including abacavir. This retrospective analysis evaluated variables potentially associated with hypersensitivity in the cohort enrolled in AI-02-001 at the University of Washington Primary Infection Clinic.

METHODS:

Cases of suspected hypersensitivity were identified prospectively and reviewed retrospectively using a standardized case definition. Controls were the remaining cohort without hypersensitivity. Univariate analyses were performed by linear logistic regression.

RESULTS:

Nine (18%) of 50 individuals treated with abacavir developed suspected hypersensitivity. Two of nine cases and no controls were HLA-B5701 positive. When antiretroviral medications were started, cases had lower mean CD8 T-cell percentage and plasma HIV RNA value. After 2 weeks on abacavir, cases had a lower mean HIV RNA value and a trend towards greater decrease in RNA. Cases began abacavir a median of 103 days after HIV acquisition compared to 48 days for controls. There was no significant in vitro abacavir-specific lymphoproliferation or IFN-gamma production in peripheral blood mononuclear cells from individuals following the suspected hypersensitivity reaction.

CONCLUSIONS:

Abacavir use during PHI may be associated with increased risk of hypersensitivity. As in chronic infection, HLA-B5701 is associated with the abacavir hypersensitivity reaction in PHI. Although levels of CD8 T cells and HIV RNA may be risk factors for hypersensitivity, the observed association may be due to correlation with HLA-B5701. The interesting temporal association of hypersensitivity with initiation of abacavir later in PHI merits future investigation.

• Authors: Joanne Stekler, Janine Maenza, Claire Stevens, Sarah Holte, Uma Malhotra, M Juliana McElrath, Lawrence Corey, Ann C Collier
• Journal: AIDS (London, England) (AIDS) Vol. 20 Issue 9 Pg. 1269-74 (Jun 12 2006) ISSN: 0269-9370 [Print] England
• PMID: 16816555 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Dideoxynucleosides
• HLA-B Antigens
• HLA-B57 antigen
• abacavir

Topics

• Adult
• Case-Control Studies
• Dideoxynucleosides (adverse effects, therapeutic use)
• Drug Hypersensitivity
• Flow Cytometry
• HIV Infections (drug therapy, immunology)
• HIV-1
• HLA-B Antigens (immunology)
• Humans
• Logistic Models
• Male
• Prospective Studies
• Retrospective Studies
• Risk
• Statistics, Nonparametric