Diagnostic accuracy of HLA-B*5701 screening for the prediction of abacavir hypersensitivity and clinical utility of the test: a meta-analytic review

Aims: This study was conducted to determine the diagnostic accuracy of HLA-B*5701 testing for prediction of abacavir-induced hypersensitivity (ABC-HSR) and to quantify the clinical benefit of pre-treatment screening through a meta-analytic review of published studies. Materials and methods: A comprehensive search was performed through PubMed, Web of Knowledge and Cochrane databases up to June 2013. The methodological quality of relevant studies was assessed by the QUADAS-2 tool. The pooled diagnostic estimates were calculated using a random effect model. Results: Pooled analysis showed that HLA-B*5701 test specificity is about 97-98%, regardless of the use of clinical criteria or of skin patch test for the diagnosis of abacavir-induced hypersensitivity. Conversely, the use of the patch test to immunologically confirm the clinical diagnosis of ABC-HSR improves sensitivity of the test from 40% to 98%. Pooled analysis of risk ratio (RR) and risk difference (RD) showed that prospective HLA-B*5701 testing significantly reduced the incidence of abacavir-induced hypersensitivity. Conclusions: The results of this meta-analysis demonstrated an excellent diagnostic accuracy of HLA-B*5071 testing to detect IC-HSR and corroborated existing recommendations for HLA-B*5701 screening before initiation of abacavir-containing therapy.