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Accepted Articles of Congress

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  • HLA-B*57:01 Screening to Prevent Abacavir Hypersensitivity and Its Effect on Virologic Suppression in HIV-1 Infection: A Systematic Review

  • Alireza Pourrahim,1,* Mohammad Mahdi Pourrahim,2 Omid Raiesi,3 Alireza Vasiee,4
    1. Student Research Committee, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
    2. Student Research Committee, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
    3. Omid Raiesi
    4. Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran


  • Introduction: Abacavir is a cornerstone of many antiretroviral regimens but carries a 5–8% risk of hypersensitivity reaction (HSR) in carriers of the HLA-B*57:01 allele. Genetic screening can virtually eliminate abacavir HSR, yet its impact on long-term virologic suppression has not been systematically quantified. This review assesses the efficacy of HLA-B*57:01 screening for preventing HSR and examines whether screening influences rates of virologic suppression in HIV-1–infected individuals.
  • Methods: We searched PubMed, EMBASE, Web of Science, and Scopus up to June 2025 for randomized trials and observational cohorts comparing screened versus unscreened patients initiating abacavir. Search terms included “HLA-B*57:01”, “abacavir”, “HIV” and their related MeSH terms. Two reviewers independently screened titles/abstracts (n=1,254), extracted data on HSR incidence, proportion achieving HIV-1 RNA <50 copies/mL at 48 weeks, and assessed study quality using the Cochrane Risk of Bias tool and Newcastle–Ottawa Scale.
  • Results: Across six studies encompassing 8,742 participants (3,512 HLA-B*57:01–screened; 5,230 unscreened), screening reduced abacavir HSR incidence from 4.7% to 0.6% (pooled RR 0.13; 95% CI 0.07–0.25; p<0.01). Virologic suppression rates at 48 weeks were 82.3% in the screened group versus 80.1% in unscreened controls (RR 1.03; 95% CI 0.99–1.07; p=0.12), indicating no significant difference. No study reported increased rates of treatment discontinuation or alternative regimen failure attributable to preemptive screening.
  • Conclusion: HLA-B*57:01 screening prior to abacavir initiation reduces hypersensitivity by 87% without compromising 48-week virologic suppression. These findings support universal screening as a cost-effective strategy to enhance the safety of abacavir-based regimens in HIV-1 treatment.
  • Keywords: HLA-B*57:01; abacavir hypersensitivity; genetic screening; virologic suppression

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