3rd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 23-26 October 2001, Athens, Greece

MONITORING OF ABACAVIR HYPERSENSITIVITY REACTION BY PHARMACISTS

Antiviral Therapy 2001; 6(Suppl. 4):35 (abstract no. 47)

SK Chuck, A Condra, DL May, PD Powers, C Landers and D Hurst
Grady Infectious Disease Program, Atlanta, Ga., USA

BACKGROUND: Hypersensitivity reaction (HSR) is complex to diagnose and patients must self monitor for early identification. HSR diagnosis is essential since abacavir rechallenge can result in death.

OBJECTIVE: To evaluate patient knowledge of HSR symptoms and to evaluate pharmacists ability to identify suspected HSR.

METHODS: Pharmacists interviewed patients using a check-box questionnaire. Symptoms evaluated included: fever, nausea, vomiting, diarrhoea, abdominal pain, tiredness, achiness, general ill feeling, sore throat, shortness of breath and cough. Symptoms were classified as chronic (CH), stable (ST) or progressive (PR). Symptoms' history, based on number and class, were used to discern the need for referral. Suspected HSR were referred to providers, clinical pharmacist (PharmD) and nurse educators (RNed). Data were collected for 6 months.

RESULTS: Seventy-two patients completed 76 interviews. Patients were 42±7 years old, 90% male, 49% black and 43% white. Duration of therapy was 4±3 months (range: 0-11); 12% initiation, 11% 1 month, 13% 2 months and 64% >2 months. Eight patients (11 %) had no knowledge of HSR; with 50% within the critical first 2 months of therapy. Forty-five percent of patients had symptoms, with 2.7±2.3 (0-10) reported per patient. Patients reported more mean symptoms at initiation (5.3) and 1 month (4) than at 2 months (1.8) and >2 months (2.3). Eleven referrals (14%) were made; providers (5), clinical pharmacists (5) and nurse educators (1). The mean number of symptoms for patients referred to providers =4 (1 CH, 2 ST, 1 PR) and clinical pharmacists =2.6 (0.5 CH, 1.8 ST, 0.3 PR). Nurse educator referrals had nine symptoms (3 CH, 2 ST, 4 PR) at initiation, which complicates HSR diagnosis later. Pharmacists identified one HSR case resulting in 1.4% prevalence. A 44-year-old black female, at 5 months of therapy with PCP, had three ST (vomiting, abdominal pain, achiness) and five PR (nausea, tiredness, ill feeling, shortness of breath, cough) which resolved when abacavir stopped.

CONCLUSION: An unacceptable HSR knowledge level of 89% exists. HSR symptoms are prevalent, especially at initiation and at 1 month. Symptom history is essential to discern suspected HSR. Pharmacists playa vital role in educating patients and screening for HSR, resulting in timely HSR diagnosis.

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