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Abacavir Hypersensitivity - HLA Testing
Abacavir is a potent, tolerable, approved NRTI for HIV-1 infection. Hypersensitivity reaction (HSR) to abacavir is reported in approximately 8% of individuals and is fatal in rare cases.
Mallal et. al. found that HLA-B*5701 was present in 14 (78%) of the 18 patients with abacavir hypersensitivity, and in four (2%) of the 167 abacavir tolerant patients (odds ratio 117 [95% CI 29-481], p<0.0001), and the HLA-DR7 and HLA-DQ3 combination was found in 13 (72%) of hypersensitive and five (3%) of tolerant patients (OR 73 [20-268], p<0.0001 ). HLA-B*5701, HLA-DR7, and HLA-DQ3 were present in combination in 13 (72%) hypersensitive patients and none of the tolerant patients (OR 822 [43-15 675], p<0.0001).
Genetic screening may be associated with reduction in the incidence of abacavir hypersensitivity and rate of false-positive diagnosis of abacavir hypersensitivity.
The Puget Sound Blood Center provides screening for HLA-B*5701, HLA-DR7, and HLA-DQ3 to evaluate risk of abacavir hypersensitivity. Average cost of the test is $200 per patient.
Mallal S, Nolan D, Witt C, Masel G, Martin AM, Moore C, Sayer D, Castley A, Mamotte C, Maxwell D, James I, Christiansen FT. Association between presence of HLA-B*5701, HLA-DR7, and HLA-DQ3 and hypersensitivity to HIV-1 reverse-transcriptase inhibitor abacavir. Lancet. 2002 Mar 2;359(9308):727-32.
Rauch A, Nolan D, Martin A, McKinnon E, Almeida C, Mallal S. Prospective genetic screening decreases the incidence of abacavir hypersensitivity reactions in the Western Australian HIV cohort study. Clin Infect Dis. 2006 Jul 1;43(1):99-102. Epub 2006 May 26.
Stekler J, Maenza J, Stevens C, Holte S, Malhotra U, McElrath MJ, Corey L, Collier AC. Abacavir hypersensitivity reaction in primary HIV infection. AIDS. 2006 Jun 12;20(9):1269-74.
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