title: A delayed hypersensitivity reaction to enfuvirtide after rechallenge.
abstract: Enfuvirtide is beneficial in patients with limited treatment options. We report this case to highlight the possibility of a delayed hypersensitivity reaction as an important potential side-effect of enfuvirtide treatment. A highly antiretroviral treatment-experienced man was commenced on a new regimen containing enfuvirtide. Prophylaxis for Pneumocystis jirovecii pneumonia was started using trimethoprim/sulphamethoxazole (TMP-STX) simultaneously. Ten days later, he developed a maculopapular rash on the chest and abdomen without any systemic features. Both enfuvirtide and TMP-STX were discontinued. Re-introduction of enfuvirtide occurred in a hospital setting. Before re-challenge, haemodynamic observations were stable. The rash re-appeared involving the whole body 5 hours post-dose and was associated with fever (temperature 38.4), nausea and a presyncopal episode. Hypersensitivity to this drug occurred immediately post-dose in phase III trials. Enfuvirtide is a useful drug in those with reduced drug options. The possibility of delayed hypersensitivity has not been reported previously.
authors.affiliation: Department of Infectious Diseases and Albion Street Centre, Prince of Wales Hospital, Sydney, Australia. carol.emerson@belfasttrust.hscni.net
authors.forename: C R
authors.initials: CR
authors.lastname: Emerson
authors.forename: J J
authors.initials: JJ
authors.lastname: Post
authors.forename: C
authors.initials: C
authors.lastname: Workman
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D004342:Drug Hypersensitivity / Q000276:immunology*; D000077560:Enfuvirtide; D005076:Exanthema / Q000276:immunology*; D015700:HIV Envelope Protein gp41 / Q000009:adverse effects* / Q000627:therapeutic use; D023581:HIV Fusion Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D010446:Peptide Fragments; D000077560:Enfuvirtide