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Research Focus: Recent Developments in HIV Therapeutics: Page 6 of 6

Research Focus: Recent Developments in HIV Therapeutics: Page 6 of 6

Fifty-four (7.3%) of 735 tests were HLA-B*5701-positive, with similar rates observed in men and women. Positive tests were reported in persons classified as white (7.6%, n = 523) and as black (9%, n = 134). Two persons who had positive HLA-B*5701 results began abacavir therapy; HSR developed in both. One hundred ninety-nine HLA-B*5701-negative persons began abacavir therapy, 47 as part of their first antiretroviral therapy regimen. Eight persons discontinued abacavir during the first 3 months of treatment, 4 for a suspected HSR, with the signs and symptoms experienced by these persons consistent with abacavir HSR. Two patients agreed to skin-patch testing for abacavir HSR, and 1 person had a positive skin-patch test. Further evaluation of this person is ongoing.

In the year before the introduction of HLA-B*5701 testing, 10 (7.5%) of 134 persons had discontinued abacavir use because of a possible HSR. After the introduction of prospective HLA-B*5701 testing, the event rate was 4 (2%) of 199, a statistically significant reduction in the event rate (P =.03).

While these data are clearly insufficient to change clinical practice or guidelines, the PREDICT-1 study will be the first randomized prospective study to assess the clinical utility of screening for HLA-B*5701 in HIV-1-infected adults.18 The results are expected in 2007. If the investigators find that this testing is useful, it may become the standard of care. Clinicians should note, however, that abacavir HSR can occur in patients who are HLA-B*5701-negative. The value of this test will be in excluding patients at high risk for abacavir HSR, ie, those who are HLA-B*5701-positive; warnings regarding abacavir HSR must still be given to all patients, and the clinician must maintain continued vigilance for abacavir HSR, even when the patient is HLA-B*5701-negative.

CONCLUSION
Developments in HIV therapeutics continue to occur at a rapid pace. As this is written, the 14th Conference on Retroviruses and Opportunistic Infections is just a few weeks away. One can expect that this conference will bring further information and surprises--some pleasant and some not.

Dr Boyle reports having received grant support from Bristol-Myers Squibb, Gilead Sciences, Pfizer, and Tibotec and speaking fees and honoraria from Bristol-Myers Squibb and Gilead Sciences. Dr Elion reports having received grant or research support from Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline, Roche Laboratories, Theratechnologies, and Tibotec; consulting fees from Bristol-Myers Squibb, Gilead Sciences, and GlaxoSmithKline; speaking fees from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Tibotec, and ViroLogic; and honoraria from all of the above. Dr Cohen reports having received consulting fees and grant or research support from Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Roche Laboratories, and Virco Lab; speaking fees from Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Roche Laboratories, and Tibotec; and honoraria from all of the above. Dr Moyle reports having received grant or research support from AnorMED, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmith-
Kline, Neurogesx, Theratechnologies, and Tibotec; consulting fees from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Incyte, Merck, Monogram Biosciences, Pfizer, Roche Laboratories, Tanox, and Tibotec; speaking fees from Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Roche Laboratories, and Tibotec; and honoraria from all of the above. No other potential conflict of interest relevant to this article was reported.

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References

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