Anaphylaxis Drug Reaction after Initiation of Bictegravir

Persons living with HIV/AIDS (PLWHA) are at higher risk of developing adverse cutaneous reactions compared to the general population [1,2]. Numerous antiretrovirals approved for HIV treatment are associated with adverse dermatological reactions such as non-nucleoside reverse transcriptase inhibitors, protease inhibitors (specifically darunavir and amprenavir), and the CD4 T-lymphocyte attachment inhibitor ibalizumab [3]. Some antiretrovirals are associated with hypersensitivity reaction, one example is PLWHA who test positive for HLA-B*5701 allele and are prescribed the nucleoside reverse transcriptase inhibitor abacavir. This type of reaction is characterized by rash, fever, malaise, and flu-like illness and is the reason why all patients should receive HLA-B*5701 screening before initiating abacavir [4]. A few antiretrovirals (nevirapine and raltegravir) have been reported to cause drug rash with eosinophilia and systemic symptoms (DRESS), nevirapine has also been associated with Stevens-Johnson Syndrome and toxic epidermal necrolysis [5-7]. These reactions can be life-threatening, but are uncommon, and typically appear days to weeks after initiation of the triggering drug. Another potentially life-threatening adverse drug reaction is anaphylaxis, which is rarely associated with antiretrovirals, only a few cases have been reported in the literature [8,9].