title: Clinical ritonavir and lopinavir hypersensitivity confirmed by a specific in vitro cellular allergen stimulation test.
abstract: A HIV-infected patient treated since eight years with all antiretroviral classes save boosted protease inhibitors, at the time of changing therapy due to an emerging genotyping resistance to non-nucleoside reverse transcriptase inhibitors, experienced repeated episodes of hypersensitivity reactions to all available boosted protease inhibitors. After documenting a combined ritonavir and lopinavir hypersensitivity by means of a specific in vitro cellular antigen stimulation test (CAST), antiretroviral therapy was safely continued with unboosted atazanavir. According to our knowledge, we report the first case of application of the in vitro CAST assay to antiretroviral intolerance, and the subsequent, specific regimen selection in a HIV-infected subject who showed multiple allergy to all boosted protease inhibitors. Further, controlled investigation is strongly needed to implement in vitro allergometric testing in patients with HIV infection and related diseases, who are prone to show unpredictable drug intolerance reactions. In fact, HIV-infected patients may suffer from frequent allergic drug reactions which may be difficult to be systematically recognized (due to the frequent, multiple concurrent pharmacotherapy), while eventual drug rechallenges are expected to be potentially dangerous.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Infectious Diseases, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. roberto.manfredi@unibo.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredi
authors.forename: Sergio
authors.initials: S
authors.lastname: Sabbatani
authors.forename: Sergio
authors.initials: S
authors.lastname: Bergonzi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000276:immunology; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007118:Immunoassay / Q000379:methods; D061466:Lopinavir; D008297:Male; D011480:Protease Inhibitors / Q000009:adverse effects* / Q000276:immunology; D011744:Pyrimidinones / Q000009:adverse effects* / Q000276:immunology; D019438:Ritonavir / Q000009:adverse effects* / Q000276:immunology
chemical_list: D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D011744:Pyrimidinones; D061466:Lopinavir; D019438:Ritonavir