Yasar BAYINDIR, Sibel ALTUNIŞIK TOPLU, Adem KÖSE, Yasemin ERSOY, Funda MEMİSOGLU, Gonca OTLU

Evaluation of HLA-B* 57:01 and its effect on antiretroviral therapy in patients with human immunodeficiency virus infection: Experience of a University Hospital

Aim: Before the decision to start abacavir (ABC), which is a member of the antiretroviral therapy (ART) combinations, the presenceof the HLA-B*57:01 allele gene should be investigated in case of hypersensitivity to the drug.In recent years, many clinics tend to conduct “treat now” policy for HIV therapy. We aimed to evaluate HLA-B*57:01 test results andits effect on the initiation time of ART, combination and changing of ART.Materials and Methods: HLA-B*57:01 screening test was evaluated retrospectively in the HIV-infected patients admitted to InonuUniversity Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology between January 2019 and December2019.Moreover, the time frame of HLA-B*57:01 tests were evaluated along with the HIV confirmation test completion time. It was evaluatedwhether there was any effect on the start of treatment and treatment change.Results: Of the 47 HIV-positive patients 44 (93.6%) were male and 3 (6.4%) were female whose HLA-B*57:01 allele was screened.The mean age ± SD of these 47 patients was 37.7 ± 13.5 years. HLA-B*57:01 gene positivity was not detected in any of our cases.After HLA-B*57:01 test detection, ten (21%) of these patients were treated with ABC sulfate plus dolutegravir sodium plus lamivudine.Five of the patients were naive patients, while the other five patients were treatment experienced.HLA-B*57: 01 allele test completion time of the patients (mean ± SD) was 4.02 ± 2.35 days. HLA-B*57:01 completion time did notdiffer statistically in patients with and without treatment change (p=0.243).Conclusion: HIV infected individuals should be started to treat with ART soon after their diagnosis. To detect the HLA-B*57:01 allelein genomic DNA is important in this period. The fact that this procedure can be performed in centers following HIV-infected patientswill positively affect the process of starting treatment.

PDF

___

1. Gunthard HF, Saag MS, Benson CA, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA 2016;316:191.
2. 2019 fact sheet. https://www.unaids.org/ Global HIV & AIDS statistics
3. Sterne JA, Hernán MA, Ledergerber B, et al. Longterm effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet 2005;366-78.
4. Martin MA, Klein TE, Dong BJ, et al. Clinical pharmacogenetics implementation consortium guidelines for HLA-B genotype and ABC dosing. Clin Pharmacol Ther 2012;91:734.
5. UK Collaborative HIV Cohort Study Steering Committee. HLA- B* 5701 status, disease progression, and response to antiretroviral therapy. AIDS. 2013;27:2587-92.
6. Phillips KA, Veenstra D, Van Bebber S, et al. An introduction to cost-effectiveness and cost-benefit analysis of pharmacogenomics. Pharmacogenomics 2003;4:231-9.
7. Hughes DA, Javier VF, Ward CC, et al. Costeffectiveness analysis of HLA B*5701 genotyping in preventing ABC hypersensitivity. Pharmacogenetics 2004;14:335-42.
8. Stainsby CM, Perger TM, Vannappagari V, et al. ABC Hypersensitivity Reaction Reporting Rates During a Decade of HLA-B* 5701 Screening as a Risk-Mitigation Measure. Pharmacotherapy 2019;39:40-54.
9. Saag M, Balu R, Phillips E, et al. High sensitivity of human leukocyte antigen-B* 5701 as a marker for immunologically confirmed ABC hypersensitivity in white and black patients. Clin Infect Dis 2008;46:1111- 8.
10. Zhang H, Zhang T, Zhao H, et al. Low prevalence of human leukocyte antigen-B*5701 in HIV-1-infected Chinese subjects: a prospective epidemiological investigation. AIDS Res Ther 2015;12-28.
11. Pynka ML , Aksak-Wąs B, Urbańska A, et al. Protective Effect of HLA-B* 5701 and HLA-C -35 Genetic Variants in HIV-Positive Caucasians from Northern Poland. PLoS ONE 2015;10:e0127867
12. Araújo C, Carvalho CV, Souza Freire MF, Yet al. Prevalence of Human Leukocyte Antigen HLA-B* 5701 in HIV-1 Infected Individuals in Brazil. J Genet 2014;4: 56-62.
13. Deveci A, Çoban AY, Durupınar B. HIV ile Enfekte Hastalarda İnsan Lökosit Antijeni (HLA)-B* 57:01 Prevalansı. Mikrobiyol Bul 2016;50:544-51.
14. Inan D, Sayan M, Deveci A, et al. HLA-B*57:01 Allele Prevalence in Turkish HIV Infected Patients and the value of Real-Time PCR Allele Testing Compored with Sequence Specific Primer Technique. HIV Drug Therapy 2020.
15. The UK Collaborative HIV Cohort Study Steering Committee. HLA B5701 status, disease progression and response to antiretroviral therapy. AIDS 2013;27:2587-92.
16. Poggi H, Vera A, Lagos M, Solari S, Rodríguez LP, Pérez CM. HLA-B*5701 frequency in Chilean HIV-infected patients and in general population. Braz J Infect Dis 2010;14:510-2.
17. Alene M, Awoke T, Yenit MK, et al. Second-line antiretroviral therapy regimen change among adults living with HIV in Amhara region: a multi-centered retrospective follow-up study. BMC Research Notes.2019;12:407.
18. Burns R, Borges J, Blasco P, et al. ‘I saw it as a second chance’: A qualitative exploration of experiences of treatment failure and regimen change among people living with HIV on second- and third-line antiretroviral therapy in Kenya, Malawi and Mozambique. Global Public Health. 2019; (Online) Journal homepage: https://www.tandfonline.com/loi/rgph20, 1706-44.