Asia Pac Allergy.  2014 Jan;4(1):54-67. 10.5415/apallergy.2014.4.1.54.

Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management

• Yunihastuti E
• Widhani A
• Karjadi TH

• KMID: 2397127
• DOI: http://doi.org/10.5415/apallergy.2014.4.1.54

Abstract

Human immunodeficiency virus (HIV)-infected patients present complex immunological alterations. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral pose these patients a higher risk of developing drug hypersensitivity. All antiretroviral agents and drugs to treat opportunistic infections have been reported to cause drug hypersensitivity reactions. Allergic reactions with antiretroviral are not restricted to older agents, although newer drugs usually more tolerated. Cutaneous adverse drug reactions are the most common manifestation of drug hypersensitivity in HIV, typically manifesting as maculopapular rash with or without systemic symptoms in the presence or absence of internal organ involvement. The onset of an allergic reaction is usually delayed. Severe drug hypersensitity reactions as erythema multiforme, Stevens Johnson syndrome and toxic epidermal necrolysis develop more often in HIV-infected patients compared to other populations. Mild to moderate rash without systemic symptom or organ involvement usually do not need drug discontinuation. Appropriate diagnosis and management of drug hypersensitivity reactions are essential, especially in patients with very low CD4+ T-cell count and multiple opportunistic infections. Clinicians should aware of different half-life of each drug when decided to stop the drug. Knowledge of the metabolism, recognition of the risk factors, and the ability to suggest the probability of particular drug as causative are also important points. A step wise rechallenge test or desensitization with the offending drug might be a preferable action and more commonly used in managing drug hypersensitivity in HIV-infected patients. Desensitization protocols have been successfully done for several antiretroviral and opportunistic infection drugs.

Keyword

Drug hypersensitivity; HIV; Desensitization

MeSH Terms

Anti-Retroviral Agents
Diagnosis*
Drug Hypersensitivity*
Drug-Related Side Effects and Adverse Reactions
Erythema Multiforme
Exanthema
Half-Life
HIV
Humans*
Hypersensitivity
Metabolism
Opportunistic Infections
Risk Factors
Stevens-Johnson Syndrome
T-Lymphocytes
Anti-Retroviral Agents

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