Open AccessHypersensitivity Reaction Associated with Abacavir Therapy in an Indian HIV Patient – A Case Report
Author(s) -
Manju Janardhanan,
V. Mohan Babu Amberkar,
Sudha Vidyasagar,
K Meena Kumari,
Sadha Holla
Publication year - 2014
Publication title -
journal of clinical and diagnostic research
Language(s) - English
Resource type - Journals
eISSN - 2249-782X
pISSN - 0973-709X
DOI - 10.7860/jcdr/2014/10063.4820
Subject(s) - abacavir , atazanavir , medicine , rash , adverse effect , discontinuation , adverse drug reaction , ritonavir , maculopapular rash , surgery , dermatology , pediatrics , drug , human immunodeficiency virus (hiv) , immunology , antiretroviral therapy , viral load , pharmacology
The most important and unique adverse effect of abacavir (ABC) is fatal hypersensitivity reaction (HSR). The objective of this report is to describe a case of ABC induced HSR that occurred in an Indian HIV patient during treatment. Although this adverse effect is not uncommon, it is perhaps underreported or has never been reported so far in an Indian case scenario. A 44-year-old known case of HIV-1 was admitted in view of his worsening condition and very low CD4 cell counts 3 cells/μL. He was on anti-retroviral therapy since three years but not regular. On the basis of treatment failure, non-compliance and progressive low CD4 counts, the anti HIV regime was switched over to abacavir 600 mg+ atazanavir/ ritonavir 300mg/100mg Two weeks after ABC therapy he presented with maculopapular rash, headache and signs of hepatic damage (serum AST, ALP and ALT increased to 3-4 fold) suggestive of hypersensitivity reaction. As we know discontinuation of the drug is the ultimate litmus test to confirm diagnosis of drug induced adverse reaction. We did confirm ABC induced HSR by de-challenge wherein, rash disappeared within 2-3 days and LFT came back to normal within 5 days. However, no rechallenge was done. HSR was more in favour of ABC because atazanavir failed to produce any similar reaction after re-challenge.