title: Abacavir-induced fulminant hepatic failure in a HIV/HCV co-infected patient.
abstract: Abacavir hypersensitivity is a rare, yet significant adverse reaction that results in a spectrum of physical and laboratory abnormalities, and has been postulated to stem from a variety of aetiological factors. The major histocompatibility complex haplotype human leucocyte antigen (HLA)-B5701 is a significant risk factor in development of hypersensitivity reactions, yet only 55% of HLA-B5701+ individuals develop such reactions, suggesting a multifactorial aetiology. Nevertheless, prospective screening and avoidance of abacavir in these patients has limited adverse events. Within this spectrum of adverse events, abacavir-induced liver toxicity is exceedingly rare and reported events have ranged from mild elevations of aminotransferases to fulminant hepatic failure. We report the case of a 50-year-old Caucasian woman with a history significant for HIV, hepatitis C virus and a HLA-B5701+ status, transferred to our emergency department in a hypotensive state and found to have acute liver failure, acute renal failure and significant rhabdomyolysis following a change of highly active antiretroviral therapy regimen.
authors.affiliation: Drexel Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Haas
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Mary Rodriguez
authors.initials: MR
authors.lastname: Ziccardi
authors.affiliation: Department of Internal Medicine/Infectious Disease, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Borgman
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D060085:Coinfection; D015224:Dideoxynucleosides / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D015235:HLA-B Antigens; D006526:Hepatitis C / Q000150:complications* / Q000276:immunology; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000276:immunology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D000099227:Abacavir
chemical_list: D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D015235:HLA-B Antigens; D000099227:Abacavir; C484830:HLA-B*57:01 antigen