Abacavir usage patterns and hypersensitivity reactions in the EuroSIDA cohort

OBJECTIVES

Five to eight per cent of HIV-positive individuals initiating abacavir (ABC) experience potentially fatal hypersensitivity reactions (HSRs). We sought to describe the proportion of individuals initiating ABC and to describe the incidence and factors associated with HSR among those prescribed ABC.

METHODS

We calculated the proportion of EuroSIDA individuals receiving ABC-based combination antiretroviral therapy (cART) among those receiving cART after 1 January 2009. Poisson regression was used to identify demographic, and current clinical and laboratory factors associated with ABC utilization and discontinuation.

RESULTS

Between 2009 and 2016, of 10 076 individuals receiving cART, 3472 (34%) had ever received ABC-based cART. Temporal trends of ABC utilization were also heterogeneous, with 28% using ABC in 2009, dropping to 26% in 2010 and increasing to 31% in 2016, and varied across regions and over time. Poisson models showed lower ABC utilization in older individuals, and in those with higher CD4 cell counts, higher cART lines, and prior AIDS. Higher ABC utilization was associated with higher HIV RNA and poor renal function, and was more common in Central-East and Eastern Europe and lowest during 2014. During 779 person-years of follow-up (PYFU) in 2139 individuals starting ABC after 1 January 2009, 113 discontinued ABC within 6 weeks of initiation for any reason [incidence rate (IR) 14.5 (95% confidence interval (CI) 12.1, 17.5) per 100 PYFU], 13 because of reported HSR [IR 0.3 (95% CI 0.1, 1.0) per 100 PYFU] and 35 because of reported HSR/any toxicity [IR 4.5 (95% CI 3.2, 6.3) per 100 PYFU]. There were no factors significantly associated with ABC discontinuation because of reported HSR/any toxicity.

CONCLUSIONS

ABC remains commonly used across Europe and the incidence of discontinuation because of reported HSR was low in our study population.

[Prevalence of tuberculous infection among health personnel]

One or more tuberculin skin tests (PPD) were carried out in 1865 members of the health care staff (71%) of the Hospital Clinic from Barcelona, so as to detect the prevalence of the infection and, particularly, to identify the converters (recently infected individuals) for the recommendation of antituberculous chemoprophylaxis. A higher number of converters was found in the group with higher risk of contagion owing to professional exposure, but the differences were not statistically significant. Significant differences were not found, either, between infected and noninfected individuals classified in risk groups. In the 1865 surveyed individuals, the initial and successive (when performed) PPD testings were negative in 987 (52%). In 775 individuals (41%), PPD reaction was positive in the initial testing. In the remaining 103 (5%), PPD reactions became positive after an initial negative result (converters). 50% of the 775 individuals with positive PPD reaction were over 35 years of age. The rate of infected individuals (positive PPD reaction) and converters was not significantly higher in those health care professionals with a supposed higher degree of exposure to infection.

[Tricuspid endocarditis in heroin addicts (author's transl)]

Two cases of tricuspid endocarditis due to Staphylococcus aureus in two young heroin addicts are reported. In one of them there was concomitant aortic valve involvement. The clinical picture was typical. Tricuspid and aortic valve vegetations were demonstrated by cardiac ultrasonography. The relatively good prognosis of tricuspid endocarditis due to Staphylococcus aureus was confirmed in one of the cases in whom an excellent response to therapy with cephalothin and gentamicin was obtained. Simultaneous aortic involvement worsens the prognosis considerably. The clinical features characteristic of endocarditis in heroin addicts are reviewed, with emphasis in those that permit to distinguish them from endocarditis in the general population. Although only indirect data are available the disease will probably be seen with increasing frequency in Spain.

[Hypercalcemia as first manifestation of thyrotoxicosis (author's transl)]

A 53-year-old woman presented a clinical picture of hypercalcemia as the first and most prominent manifestation of hyperthyroidism. The possibility of a coexistent hyperparathyroidism was excluded, as well as any other potential cause of hypercalcemia. The hypercalcemia and its clinical manifestations disappeared a month after the antithyroid therapy was started. After 2 years, the calcemia and renal and thyroid functions continue normal. The association of hyperthyroidism and hypercalcemia is well known, but only rarely is hypercalcemia responsible for prominent clinical symptoms. It is very infrequent for the manifestations of hypercalcemia to precede those of hyperthyroidism.