Association of HLA-B*53 with DRESS syndrome in patients treated with raltegravir: a cohort study and literature review

Introduction: Raltegravir, an HIV integrase inhibitor, although generally well-tolerated may cause severe reactions such as DRESS syndrome. DRESS is associated with impaired drug metabolism, viral reactivation, and alleles like HLA-B*53:01 . This study examines the prevalence of HLA-B*53:01 and its association with DRESS in raltegravir-treated patients. Method: ology: Medical records from Hospital Universitario de La Princesa (2008–2020) were reviewed to identify patients genotyped for HLA-B*53 who received raltegravir. Suspected DRESS cases were assessed using the RegiSCAR scoring system and Naranjo algorithm. A literature review identified additional cases. Results: : Among 109 patients treated with raltegravir, three (2.8%) carried HLA-B53. Two carriers (66.7%) developed DRESS, while no adverse reactions were reported in non-carriers. The first case, a 43-year-old male, presented fever, rash, lymphadenopathy, liver dysfunction, and HHV-6 reactivation (RegiSCAR score 6). The second, a 59-year-old male, showed eosinophilia, rash, and pulmonary symptoms (score 4). The third carrier remained asymptomatic. Relative risk for HLA-B*53 carriers was 128.75. Nine additional DRESS cases associated with raltegravir were found in the literature and summarized in a table including clinical features and HLA-B*53 status. Conclusion: Findings support a genetic predisposition involving HLA-B*53:01 in DRESS. Given overlap with IRIS, further research on diagnosis and treatment is needed. Screening for HLA-B*53 may be useful before raltegravir use in high-prevalence populations.