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HIV-related dermatological emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
S. Yogesh Marfatia, J. Ruchi Shah
Hypersensitivity reaction occurs after initiation of abacavir in approximately 3.7% patients on cART [25]. Abacavir hypersensitivity is strongly associated with major histocompatibility complex allele and human leukocyte antigen (HLA)B*5701 [26]. Screening for allele is thus recommended prior to initiation of the drug. Prompt stoppage of the drug, IV hydration, and administration of a short course of systemic steroids in the dose of 0.5–1 mg/kg/day rapidly improves the symptoms as well as the laboratory parameters.
Abacavir
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Paul U. Cameron, Jason A. Trubiano
Abacavir is a potent NRTI that is useful as part of the nucleoside analog backbone within combination antiretroviral regimens for HIV infection in both the developed and the developing world. The risk of hypersensitivity reactions associated with abacavir therapy is now uncommon with the use of HLA-B*5701 testing before prescribing abacavir. The D:A:D study exposed a potential risk of cardiovascular disease associated with abacavir use, which is undergoing further investigation. The clinical use of abacavir in the management of HIV infection under various conditions is discussed. The use of the abacavir–lamivudine combination for treatment (Achenbach et al., 2010) and the fixed-dose combination abacavir–lamivudine–dolutegravir are also reviewed in the following sections (Walmsley et al., 2013).
Cutaneous Manifestations of Highly Active Antiretroviral Therapy
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Deborah B. Henderson, Clay J. Cockerell
Side-effects of abacavir include gastrointestinal upset and a cutaneous eruption. In 2–3% of cases, a multisystem hypersensitivity reaction may be observed within 6 weeks. The symptoms of this phenomenon include fever, morbilliform cutaneous eruption, nausea, diarrhea, hypotension, and respiratory or musculoskeletal dysfunction.21 In general, the characteristic skin finding is a mild to moderately severe eruption that is generally less severe than that seen with the NNRTIs.22 However, continued use of abacavir in the setting of hypersensitivity may lead to fatal complications; thus, current clinical guidelines recommend discontinuation of the abacavir with the appearance of a systemic allergic reaction. Similarly, rechallenge with abacavir after such a reaction is not advised as there have been rare cases of severe erythema multiforme (EM) developing as a consequence.23 Patch testing with abacavir has been utilized in attempts to confirm the medication as the causal agent of cutaneous hypersensitivity and it may be useful in some cases.24
“High” antiretroviral deintensification, a strategy to avoid drug interactions and unfavourable long-term effects of HAART
Published in Infectious Diseases, 2018
Massimiliano Lanzafame, Daniela Piacentini, Emanuela Lattuada, Sebastiano Rizzardo, Sheila Chiesi, Sandro Vento
The nine patients on nevirapine 200 mg stopped abacavir after a mean length of viral suppression of 35.11 months. As for the eight patients on efavirenz 400 mg, the dose was reduced to 200 mg after a mean time of viral suppression of 38.1 months. The last step for the eight patients on efavirenz was to stop tenofovir (3) or abacavir (5) after a mean time of viral suppression, on a 200 mg efavirenz regimen, of 36.1 months. All the patients, on lamivudine plus nevirapine 200 mg once daily and on lamivudine plus efavirenz 200 mg once a day were virally suppressed (HIV RNA <20 copies/ml) at the last test, with a mean length of viral suppression of 11.9 months. Pharmacokinetics analysis was performed in six patients on nevirapine and seven patients on efavirenz (Table 1). Ctrough of nevirapine was measured twice: 6 months after dose reduction from 400 to 200 mg and six months after stopping abacavir.
The dawn of precision medicine in HIV: state of the art of pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2018
Ying Mu, Sunitha Kodidela, Yujie Wang, Santosh Kumar, Theodore J. Cory
CCR5 antagonist test and HLA-B*5701 allele test are two other lab tests recommended by FDA for ART administration. Identifying the pharmacogenetics of patients’ is another way to apply for the precision medicine. Patients with the HLA-B*5701 allele are at a higher risk of hypersensitivity to react with abacavir. HLA-B*5701 screening is recommended prior to prescribing abacavir. GT of viral tropism is widely used in the clinical settings to test patient’s [171] dominant virus population. The genetic test of CYP2B6 516 G > T is useful to identify side effects of patients using efavirenz. UGT1A1*28 testing prior administration of ATV can reduce the risk of hyperbilirubinemia. These current tests in the clinic are essential to practice precision antiretrovirals. However, improvements are in need: patients’ genetic tests are not always available, and the tests can be costly and time consuming. Furthermore, drug response may be effected by multiple genes and not just the one code for the specific protein. These tests reduce the risk of side effects and improve drug efficacy, but going forward will require knowledge of genetic risk factors and the development of new DNA technologies. With advanced knowledge of the human genome and new technologies, including DNA microarrays, DNA chips, and human genome analysis, in the future patients’ specific gene characteristics will be basic information for physicians to choose drug combinations, optimizing drug concentration and minimizing the side effects.
Implementation and new insights in molecular diagnostics for HIV infection
Published in Expert Review of Molecular Diagnostics, 2018
Hin-Fung Tsang, Lawrence Wing-Chi Chan, Jennifer Chiu-Hung Tong, Heong-Ting Wong, Christopher Koon-Chi Lai, Thomas Chi-Chuen Au, Amanda Kit-Ching Chan, Lawrence Po-Wah Ng, William Chi-Shing Cho, Sze-Chuen Cesar Wong
Another promising application of dPCR in viral diagnostics is the improved detection of low abundance mutant sequences, such as those contributing to antiviral resistance, from high abundance wild-type sequences [25]. In terms of pharmacogenomics, dPCR plays important role in achieving personalized medicine. Taking abacavir, a small molecule reverse transcription inhibitor against HIV, is one of the commonly used treatment options. However, 5–8% of patients taking abacavir would develop life-threatening hypersensitivity against the drug. Mallal et al. identified the association between HLA-B*5701 and abacavir hypersensitivity reaction [26]. To reduce the incidence of abacavir hypersensitivity reaction, genetic screening is now recommended by many HIV treatment guidelines before initiation of abacavir treatment [27].