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PP 4.22
The incidence and reasons of the premature giving up of abacavir in HIV patients
within 2 months following the treatment setting-up
FOUCHER N.,AZARD J.,PERTUSA MC.,BERNARD N.,LACOSTE D.,MORLAT P.,
POMETAN JP.
Service pharmacie et Service de Médecine interne et maladies infectieuses, hôpital Saint
André, Bordeaux, France
Background
Abacavir is a nucleoside reverse-transcriptase inhibitor (NRTI) whose most characteristic
adverse effect is an hypersensibility reaction (HSR) which usually occurs in the first 6
weeks of treatment. This adverse effect causes the final adoption of the treatment with
formal prohibition of a new prescription of this molecule.
Objectives
Determine the incidence of abacavir giving up within 2 months following its setting-up and
analyse their reasons. Identify the number of abacavir giving up due to true HSR
according to its definition criteria.
Methods
This retrospective study concerns 628 patients who had begun a treatment by abacavir
between January 1998 and January 2006. This cohort is extracted from the Pharmatip
software, used in the pharmacy of the Saint Andre hospital (CHU Bordeaux), which allows
a monthly delivery of the ARV drugs. We selected the patients who gave up abacavir and
who received a substitute treatment delivered by the pharmacy during at least one year.
Thus, the files of 32 patients were studied to evaluate the causes of abacavir giving up.
We retained the usual criteria of HSR's definition: presence of at least 2 signs among
fever, cutaneous eruption, gastrointestinal symptoms, lethargy, malaise and respiratory
symptoms, in coherence with the time of appearance of the symptoms, their aggravation
during the treatment and their fast resolution at abacavir giving up.
Results
Of the 628 patients exposed to abacavir, 32 patients (5,1%) gave up abacavir in the first
2 months and their substitute treatment could be followed by the pharmacy. Among these
32 patients, 10 patients presented a true HSR, 15 did not develop HSR and 7 cases were
doubtful due to the lack of precision in the file. We obtained an incidence of 5,1% for
abacavir giving up due to the appearance of adverse effects but the incidence of the true
HSR was only 1,6%. The signs observed in the cases of undeniable HSR confirm the
definition of an abacavir HSR: 80% presented fever, 60% lethargy or feeling of faintness,
60% gastrointestinal symptoms and 50% a cutaneous eruption. Among the 10 true HSR,
3 patients had a treatment by INNTI associated, 2 patients among the 15 non HSR cases
and 2 among the doubtful cases.
POSTERS
Conclusion
This work made it possible to identify the patients having develop an abacavir HSR and
to announce them to whole the medical community of Bordeaux. This study, in clinical
practice, shows that true HSR is not the majority cause of abacavir treatment giving up.
Very often, the least suspicion of a HSR leads to the treatment giving up. These
excessive abacavir giving up do not allow certain patients to profit from this molecule for
the rest of their life.
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