Carolino Fabrícia, Santos Natacha, Piñeiro Carmela, Santos Ana Sofia, Soares Pedro, Sarmento António, Cernadas Josefina Rodrigues
Serviço de Imunoalergologia, Centro Hospitalar São João, E.P.E., Porto, Portugal.
Serviço de Doenças Infecciosas, Centro Hospitalar São João, E.P.E., Porto, Portugal.
Porto Biomed J. 2017 Mar-Apr;2(2):59-62. doi: 10.1016/j.pbj.2016.12.004. Epub 2017 Feb 4.
Human Immunodeficiency Virus (HIV)-positive patients treated with the antiretroviral drug abacavir (ABC) may develop a potentially fatal ABC-associated hypersensitivity syndrome (ABC-HS), typically characterized by fever, malaise, rash, vomiting/diarrhoea and/or dyspnoea/cough. ABC-HS has been strongly associated with HLA-B*57:01 carriage and screening for this allele is recommended.
To determine the prevalence of HLA-B*57:01 and to characterize suspected ABC-HS in the adult HIV population from our hospital during a 7-year period.
Clinical data on patients under ABC treatment from January 2006 to December 2012 were analyzed to search for symptoms of ABC-HS. Reactions of suspected ABC-HS were characterized. HLA-B57:01 and patch tests (1% and 10% ABC in petrolatum) with readings at 48 h were performed in those without previous testing. From January 2008 routine HLA-B57:01 screening was implemented.
From January 2006 to December 2007, 186 patients began treatment with ABC (data from 163 were available): 7 (4%) patients stopped ABC for suspected ABC-HS (71% males, median age 45 years) and the median time for onset of the reaction after starting ABC was 7 days. Four of the 7 patients had the HLA-B57:01 allele and 2 of these 4 had positive patch tests. After HLA-B57:01 screening implementation (January 2008), 573 patients were evaluated and 35 (6.1%) were HLA-B*57:01 positive; no suspected ABC-HS were observed since then.
Four patients with suspected ABC-HS (of 6 screened) were HLA-B57:01 positive. No ABC-HS occurred since January 2008, after HLA-B57:01 screening was implemented.
接受抗逆转录病毒药物阿巴卡韦（ABC）治疗的人类免疫缺陷病毒（HIV）阳性患者可能会发生潜在致命的阿巴卡韦相关超敏反应综合征（ABC-HS），其典型特征为发热、不适、皮疹、呕吐/腹泻和/或呼吸困难/咳嗽。ABC-HS与HLA-B*57:01携带密切相关，建议对此等位基因进行筛查。
确定我院7年间成年HIV人群中HLA-B*57:01的流行率，并对疑似ABC-HS进行特征描述。
分析2006年1月至2012年12月接受ABC治疗患者的临床资料，以寻找ABC-HS的症状。对疑似ABC-HS的反应进行特征描述。对未进行过检测的患者进行HLA-B57:01检测和斑贴试验（凡士林基质中1%和10%的ABC），并在48小时读取结果。自2008年1月起实施常规HLA-B57:01筛查。
2006年1月至2007年12月，186例患者开始接受ABC治疗（可获得163例患者的数据）：7例（4%）患者因疑似ABC-HS停用ABC（71%为男性，中位年龄45岁），开始使用ABC后反应发作的中位时间为7天。7例患者中有4例携带HLA-B57:01等位基因，这4例中有2例斑贴试验呈阳性。自实施HLA-B57:01筛查（2008年1月）后，对573例患者进行了评估，35例（6.1%）HLA-B*57:01呈阳性；此后未观察到疑似ABC-HS病例。
6例接受筛查的疑似ABC-HS患者中有4例HLA-B57:01呈阳性。自2008年1月实施HLA-B57:01筛查后，未发生ABC-HS病例。
