International Journal of STD & AIDS > Volume 20, Number 4 > Pp. 288-289

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Case reports

A delayed hypersensitivity reaction to enfuvirtide after rechallenge

C R Emerson MRCP Dip HIV ^*  , J J Post PhD FRACP ^*   and C Workman MBBS 

^* Department of Infectious Diseases and Albion Street Centre, Prince of Wales Hospital; Prince of Wales Clinical School; School of Medical Sciences, University of New South Wales, Sydney, Australia; AIDS Research Initiative, Sydney, Australia

Correspondence to: Dr C R Emerson, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6AB, UK Email: carol.emerson{at}belfasttrust.hscni.net

Enfuvirtide is beneficial in patients with limited treatment options. We report this case to highlight the possibility of a delayed hypersensitivity reaction as an important potential side-effect of enfuvirtide treatment. A highly antiretroviral treatment-experienced man was commenced on a new regimen containing enfuvirtide. Prophylaxis for Pneumocystis jirovecii pneumonia was started using trimethoprim/sulphamethoxazole (TMP-STX) simultaneously. Ten days later, he developed a maculopapular rash on the chest and abdomen without any systemic features. Both enfuvirtide and TMP-STX were discontinued. Re-introduction of enfuvirtide occurred in a hospital setting. Before re-challenge, haemodynamic observations were stable. The rash re-appeared involving the whole body 5 hours post-dose and was associated with fever (temperature 38.4), nausea and a presyncopal episode.

Hypersensitivity to this drug occurred immediately post-dose in phase III trials. Enfuvirtide is a useful drug in those with reduced drug options. The possibility of delayed hypersensitivity has not been reported previously.

Key Words: HIV • hypersensitivity • enfuvirtide

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