abacavir and Exanthema

The primary goal of the highly active antiretroviral treatment is to improve HIV-infected patient immune function through maintaining viral suppression. However, this treatment may lead to adverse events, some of them potentially serious. This article emphasizes on the antiretroviral therapy associated adverse events and their management recommendations, especially for serious or potentially life-threatening cases. Adverse events analyzed in this article include side effects derived from mitochondrial toxicity, abacavir hypersensitivity reaction, hepatotoxicity, skin rash and Stevens-Johnson syndrome, increased bleeding episodes in hemophilic patients and nephrotoxicity. In some cases, a high suspicion is needed because the onset symptoms may be unspecific.

Topics: Antiretroviral Therapy, Highly Active; Dideoxynucleosides; Exanthema; Hemorrhage; HIV Infections; Humans; Liver Failure; Mitochondrial Myopathies; Stevens-Johnson Syndrome

CIRCUMSTANCES AND CHARACTERISTICS: The risk of toxiderma is greater in patients infected by the human immunodeficiency virus (HIV). The most common toxidermas are maculopapular exanthema and drug hypersensitivity reactions. These toxidermas are predominantly observed with non-nucleoside reverse transcriptase analogs (nevirapine, efavirenz) and abacavir. Toxiderma has also been observed with other nucleoside reverse transcriptase analogs (zalcitabine) and protease inhibitors. REGARDING SEVERITY: The toxidermas observed are usually benign (maculopapular exanthema) and do not always require suspension of the treatment. However, certain toxidermas (Stevens-Johnson syndrome, Lyell syndrome and drug hypersensitivity syndrome) may be life-threatening and therefore contraindicate the continuation of treatment and also its sudden reintroduction. PREVENTION AND PRACTICAL APPROACH: Several studies have assessed the risk factors for toxiderma induced by nevirapine and hypersensitivity reactions to abacavir. The practical approach varies depending on the drug responsible, the clinical form of the toxiderma and the possible alternatives.

Topics: Alkynes; Anti-HIV Agents; Anti-Inflammatory Agents; Benzoxazines; Cyclopropanes; Dideoxynucleosides; Drug Hypersensitivity; Exanthema; Histamine H1 Antagonists; HIV Infections; HIV Protease Inhibitors; Humans; Nevirapine; Oxazines; Reverse Transcriptase Inhibitors; Risk Factors; Steroids; Stevens-Johnson Syndrome

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.

Topics: Adult; Dideoxynucleosides; Exanthema; Female; Fever; HIV Infections; HIV-1; HLA-B Antigens; Humans; Reverse Transcriptase Inhibitors