Hypersensitivity to antiretroviral drugs

Abstract

Background. Antiretroviral treatment improved the prognosis of patients with Human Immunodeficiency Virus (HIV) infection. Antiretroviral drugs may be responsible for hypersensitivity reactions varying in severity, clinical manifestations and frequency. Individuals infected with HIV show an increased frequency of drug eruptions when compared with general population. Reports of delayed allergic reactions to antiretroviral drugs in patients with HIV have been described, but diagnostic methods are scarce. Case report. We report the case of a 47-year-old woman, with diagnosis of HIV infection since 2009, who developed a delayed mucocutaneous reaction after treatment with antiretroviral drugs. Hypersensitivity reaction (HR) to emtricitabine and tenofovir was considered probable based on positive patch tests (PT), which were negative in 7 controls. Delayed HR to nevirapine was confirmed by drug provocation test. Discussion. The diagnosis of HR to antiretroviral drugs in patients with HIV infection remains a diagnostic challenge, partly due to unknown mechanism and to the absence of validated diagnostic tools. Patch testing may represent a useful method for confirming hypersensitivity to antiretroviral drugs, however the use of PT is not widespread, so the predictive value of testing has not been ascertained. Further investigation in this area is required to elucidate the mechanisms in HIV-infected patients, so that successful management strategies can be offered, preventing loss of potent and viable antiretroviral agents.