In individuals with the HLA-B*57:01 variant allele ("HLA-B*57:01-positive"), abacavir is not recommended and should be considered only under exceptional circumstances. See full guideline for disclaimers, further details and supporting evidence.
Accepted article preview online 21 February 2014; Advance online publication 12 March 2014
The 2014 update of CPIC guidelines regarding abacavir has been published in Clinical Pharmacology and Therapeutics. Literature published between April 2011-November 2013 was reviewed and there is no new evidence that would change the original guidelines. Therefore, the dosing recommendations in the original publication remain clinically current.
- These guidelines are applicable to:
- HIV Patients
- Download and read:
Advance online publication February 2012
- Download and read:
Excerpt from the abacavir dosing guidelines:
We agree with others* that HLA-B*57:01 screening should be performed in all abacavir-naive individuals before initiation of abacavir-containing therapy (see Table 1 below); this is consistent with the recommendations of the FDA, the US Department of Health and Human Services, and the European Medicines Agency. In abacavir-naive individuals who are HLA-B*57:01-positive, abacavir is not recommended and should be considered only under exceptional circumstances when the potential benefit, based on resistance patterns and treatment history, outweighs the risk.
Table 1: Recommended therapeutic use of abacavir based on HLA-B genotype
Adapted from Tables 1 and 2 of the 2012 guideline manuscript.
|Likely phenotype||Genotypes||Examples of diplotypes||Implications for phenotypic measures||Recommendations for abacavir therapy||Classification of recommendation for abacavir therapy a|
|Very low risk of hypersensitivity (constitutes ~94% b of patients)||Absence of *57:01 alleles (reported as "negative" on a genotyping test)||*X/*X c||Low or reduced risk of abacavir hypersensitivity||Use abacavir per standard dosing guidelines||Strong|
|High risk of hypersensitivity (~6% of patients)||Presence of at least one *57:01 allele (reported as "positive" on a genotyping test)||*57:01/*X c *57:01/*57:01||Significantly increased risk of abacavir hypersensitivity||Abacavir is not recommended||Strong|
a Rating scheme described in the 2012 Supplement
b See the 2012 Supplement for estimates of genotype frequencies among different ethnic/geographic groups
c *X = any HLA-B genotype other than *57:01.
HLA-B = human leukocyte antigen B
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