Session:

HIV/AIDS & Other Retroviruses

Abstract No.:

43.025

Title:

Low prevalence of HLA B5701 among HIV-infected Thai children in Thailand and Cambodia; implication for abacavir use

Author(s):

T. Puthanakit¹, J. Ananworanich², S. Vonthanak³, W. Luesomboon⁴, J. Wongsawat⁵, C. Ngampiyaskul⁶, S. Kanjanavanit⁷, S. Ubolyam⁸, R. Hansudewechakul⁹, U. Vibol¹⁰, P. Kosalaraksa¹¹, T. Bunupuradah¹², K. Ruxrungtham¹³; ¹HIV-NAT, TRC-ARC and the Chulalongkorn University, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok/TH, ²HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Center; SEARCH; and Chulalongkorn University, Department of Medicine, Bangkok/TH, ³National Center for HIV/AIDS, Dermatology and STDs , (NCHADS), Phnom Penh/KH, ⁴Queen Savang Vadhana Memorial Hospital, Department of Pediatrics, Chonburi/TH, ⁵Bamrasnaradura Infectious Disease Institute, Ministry of Public Health, Nonthaburi/TH, ⁶Prapokklao Hospital, Department of Pediatrics, Chantaburi/TH, ⁷Nakornping Hospital, Department of Pediatrics, Chiang Mai/TH, ⁸HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Center, (HIV-NAT), Bangkok/TH, ⁹Chiangrai Prachanukroh Hospital, Department of Pediatrics, Chiang Rai/TH, ¹⁰National Pediatric Hospital, National Pediatric Hospital, Phonm Pehn/KH, ¹¹Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen/TH, ¹²HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Center, HIV-NAT, Bangkok/TH, ¹³HIV Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Center and Chulalongkorn University, Department of Medicine, Bangkok/TH

Abstract:

Background: Abacavir is a nucleoside reverse transcriptase inhibitor for treating human immunodeficiency virus (HIV) infection with minimal mitochondrial toxicity and lipodystrophy. Abacavir hypersensitivity is strongly associated with the human leukocyte antigen (HLA)-B*5701 allele. HLA-B*5701 screening, recommended prior to initiating abacavir especially in population with prevalence > 5%, is not widely accessible in the developing world. The prevalence of HLA*5701 in Caucasians is as high as 7-9%. However, there are limited data among Asians.
Methods: This is a substudy of the PREDICT study, a randomized trial of immediate versus deferred antiretroviral initiation in HIV-infected children aged 1-12 years in Thailand and Cambodia. The HLA typing was performed by Hiseq single-end sequencing of the amplicon and analysis by the Bejing Genomic Institute developed software.
Results: There were 140 HIV-infected children in this substudy. The median (interquartile range) age was 6.5 (4.2-8.7) years, 36% were male, 80 (57%) were Thai and 60 (43%) were Cambodian. The prevalence of HLA-B*5701 was 2.5% (95% CI 3.0-8.7%) among Thai and 1.7% (95%CI 0.4-8.9%) among Cambodian children.
Conclusion: While routine screening for HLA-B*5701 prior to initiating ABC is recommended when available, this study suggests that HLA-B*5701 prevalence in Thai and Cambodian children may be under 5%.  Early detection of ABC hypersensitvity reaction (HSR) through close clinical monitoring remains important, whether or not HLA-B*5701 screening has been performed.