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Hypersensitivity to antiretroviral drugs a case report

机译：对抗逆转录病毒药物过敏的一例报告

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BackgroundARVT (antiretroviral treatment) improved the prognosisof patients with HIV (Human Immunodeficiency Virus)infection. Antiretroviral drugs may be responsible for HR(hypersensitivity reactions) varying in severity, clinicalmanifestations and frequency.MethodsWe report a case of a 47-year-old woman, with diagnosisof HIV infection since 2009 (HLA B5701 negative) thatstarted ARVT in 2011. On the 2nd day of treatment withTenofovir, Emtricitabine and Nevirapine she developedpruritic exanthema and palpebral edema. Two weeks laterthe Infecciologist discontinued ARVT and prescribed AH(antihistamines) and CS (oral corticosteroids) withsymptoms resolution. One month later treatment withTenofovir and Emtricitabine was restarted in associationwith Darunavir and Ritonavir. There was a reproduciblereaction on the 2nd day of treatment. After the reactionsubsided, the patient restarted Darunavir and Ritonavir inassociation with Abacavir and Lamivudine. On the2nd day she developed palpebral edema and discontinuedARVT once again. She was then referred to our DrugAllergy Clinic for suspected hypersensitivity to ARVT.ResultsPT (patch tests) with the suspected drugs were positive forEmtricitabine and Tenofovir and revealed only erythemato Lamivudine. PT performed in 7 controls were negative.Negative DPT (drug provocation test) with Darunavir,Ritonavir and Abacavir were followed by home treatmentwith no adverse reactions. DPT with Nevirapine waspositive (pruritic exanthema and palpebral edema). DPTwith an alternative drug, Raltegravir, was negative.ConclusionHR to Darunavir, Ritonavir and Abacavir were excluded,so the patient restarted treatment with these drugs. Sincecombined therapy with 3 or more drugs is recommendedto avoid viral resistance, Raltegravir was introduced tocomplete therapeutic regimen. HR to Nevirapine wasconfirmed and HR to Emtricitabine and Tenofovir wasconsidered probable based on positive PT. We admita possible cross-reactivity with Lamivudine.
机译：背景技术ARVT（抗逆转录病毒治疗）改善了HIV（人类免疫缺陷病毒）感染患者的预后。抗逆转录病毒药物可能是导致HR（超敏反应）的严重程度，临床表现和频率变化的原因。方法我们报道了一名47岁的女性，该女性自2009年以来被诊断为HIV感染（HLA B5701阴性），该患者于2011年开始接受ARVT。用替诺福韦，恩曲他滨和奈韦拉平治疗的第二天，她出现了瘙痒性皮疹和睑板水肿。两周后，流行病学家终止了ARVT并开具症状缓解的AH（抗组胺药）和CS（口服皮质类固醇）。一个月后，替诺福韦和恩曲他滨联合达鲁那韦和利托那韦重新开始治疗。治疗第二天有可重复的反应。反应平息后，患者重新开始了与阿巴卡韦和拉米夫定联用的达鲁纳韦和利托那韦联合治疗。第二天，她出现了睑水肿，并再次终止了ARVT。然后，她因涉嫌对ARVT过敏而被转诊至我们的药物过敏诊所。结果疑似药物的PT（贴片测试）对艾美曲他滨和替诺福韦呈阳性，仅显示红斑拉米夫定。 7例患者的PT均为阴性。Darunavir，Ritonavir和Abacavir的DPT（药物激发试验）阴性，随后接受家庭治疗，无不良反应。 DPT与奈韦拉平呈阳性（瘙痒性皮疹和睑水肿）。结论DPT与替代药物Raltegravir阴性。由于推荐使用3种或3种以上药物的联合治疗以避免病毒耐药，因此引入Raltegravir来完成治疗方案。基于阳性PT，证实了对奈韦拉平的HR，并且认为对恩曲他滨和替诺福韦的HR可能。我们承认与拉米夫定可能发生交叉反应。

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