HLA-dependent hypersensitivity to nevirapine in Sardinian HIV patients
HLA-dependent hypersensitivity to nevirapine in Sardinian HIV patients
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DOI：
10.1097/01.aids.0000238408.82947.09
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发表时间：
2006-08-01
期刊：
影响因子：
3.8
通讯作者：
Manconi, Paolo Emilio
中科院分区：
文献类型：
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作者：
Littera, Roberto;Carcassi, Carlo;Manconi, Paolo Emilio
工作背景：超敏反应奈韦拉平，这在某些情况下可能是致命的，显示了较高的患病率在撒丁岛相比，与其他意大利regions.Objective：这项研究表明，超敏反应奈韦拉平在撒丁岛HIV感染患者与HLA CW 8-B14单倍型。这两个HLA I类抗原是在强烈的连锁不平衡在撒丁岛population.Methods：四十九撒丁岛HIV阳性患者与奈韦拉平进行了研究。13例（26%）患者出现过敏反应，因此需要停药。在奈韦拉平超敏和耐药患者中进行HLA I类和II类分子分型。为了避免在两组治疗的患者的等位基因频率的偏见代表，分子分型也进行了82 HIV阳性患者谁没有被治疗nevirapine.Results：观察到相当大的重叠的临床，免疫学和人口统计学特征的13过敏患者和36宽容的患者。临床参数包括病毒载量、HIV感染状态、CD 4和CD 8细胞计数、丙型肝炎病毒/B型肝炎病毒合并感染。46%（6/13）的奈韦拉平过敏受试者具有HLA-Cw 8和HLA-B14（65）抗原，而奈韦拉平耐受组为5%（2/36）（P = 0.004; P-c = 0.05）。与最近的其他报告一致，证实了HIV患者中HLA分型在识别可能导致药物引起的过敏反应易感性的遗传因素方面的实用性。在易感个体中谨慎选择抗逆转录病毒治疗应显著降低严重过敏反应的风险。(c)2006年利平科特威廉姆斯&威尔金斯。
Background: Hypersensitivity reaction to nevirapine, which in some cases can be fatal, shows a higher prevalence in Sardinia in comparison with other Italian regions.Objective: This study demonstrates that hypersensitive reaction to nevirapine in Sardinian HIV-infected patients is associated with the HLA CW8-B14 haplotype. These two HLA class I antigens are in strong linkage disequilibrium in the Sardinian population.Methods: Forty-nine Sardinian HIV-positive patients treated with nevirapine were studied. Thirteen (26%), developed a hypersensitive reaction thus requiring the drug to be discontinued. HLA class I and II molecular typing was performed in both nevirapine-hypersensitive and nevirapine-tolerant patients. To avoid biased representation of the allele frequencies in the two groups of treated patients, molecular typing was also performed in 82 HIV-positive patients who had not been treated with nevirapine.Results: Considerable overlap was observed for the clinical, immunological and demographic characteristics of the 13 hypersensitive patients and 36 tolerant patients. Clinical parameters included viral load, status of HIV infection, CD4 and CD8 cell counts, hepatitis C virus/hepatitis B virus co-infections. Forty-six percent (6/13) of the nevirapine-hypersensitive subjects had the HLA-Cw8 and HLA-B14(65) antigens compared with 5% (2/36) of the nevirapine-tolerant group (P = 0.004; P-c = 0.05).Conclusion: In agreement with other recent reports, the utility of HLA typing in HIV patients to identify genetic factors that may confer susceptibility to drug-induced hypersensitive reaction was confirmed. A careful choice of antiretroviral therapy in susceptible individuals should significantly reduce the risk of severe hypersensitive reaction. (c) 2006 Lippincott Williams & Wilkins.