Phillips Elizabeth, Mallal Simon
Centre for Pharmacology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
Curr Opin Allergy Clin Immunol. 2007 Aug;7(4):324-30. doi: 10.1097/ACI.0b013e32825ea68a.
Drug hypersensitivity has been reported to occur 100 times more commonly in those living with HIV. In the first decade of HIV treatment, this mainly involved drugs used to treat HIV-related infections but now primarily includes drugs used to treat HIV. This review focuses on the current knowledge of the epidemiology, pathophysiology and clinical features of drug hypersensitivity reactions of drugs used in the management of the HIV-infected patient.
Our understanding of the immunogenetics and host predisposition to drug hypersensitivity has been advanced considerably by the antiretroviral drugs abacavir and nevirapine. The association of abacavir hypersensitivity reaction with HLA-B*5701 has been particularly important and provides a basis for genetic screening in the clinic setting.
The increased predisposition of drug hypersensitivity disease in HIV will continue to provide a fertile ground for study of the diverse and complex processes that drive its pathophysiology. Our knowledge of drug hypersensitivity will also increase as the expanding armentarium of antiretroviral therapy is applied to more diverse populations in the developing world. The potential for widespread implementation of HLA-B*5701 screening for abacavir hypersensitivity will set an important precedent for bringing individualized medicine to the clinic and the use of genetic testing to improve drug safety.
据报道，药物超敏反应在HIV感染者中发生的频率比普通人高100倍。在HIV治疗的第一个十年中，这主要涉及用于治疗HIV相关感染的药物，但现在主要包括用于治疗HIV的药物。本综述重点关注目前关于HIV感染患者治疗中所用药物的药物超敏反应的流行病学、病理生理学和临床特征的知识。
抗逆转录病毒药物阿巴卡韦和奈韦拉平极大地推进了我们对药物超敏反应的免疫遗传学和宿主易感性的理解。阿巴卡韦超敏反应与HLA-B*5701的关联尤为重要，并为临床环境中的基因筛查提供了基础。
HIV患者中药物超敏疾病易感性的增加将继续为研究驱动其病理生理学的多样和复杂过程提供肥沃的土壤。随着抗逆转录病毒疗法不断扩大的药物库应用于发展中世界更多样化的人群，我们对药物超敏反应的认识也将增加。对阿巴卡韦超敏反应进行HLA-B*5701筛查的广泛实施潜力将为将个性化医疗引入临床以及利用基因检测提高药物安全性树立重要先例。
