South Africa continues to grapple with a high prevalence of HIV and TB-infected patients, with co-infection often being commonplace. These patients experience immune dysregulation and multiple drug exposures and with that are at increased susceptibility to drug hypersensitivity (allergy) and developing adverse drug reactions, such as life-threatening severe cutaneous adverse reactions (SCARs), which are dermatologic or skin reactions.
Research which has jointly been supported by the South African Medical Research Council (SAMRC) / National Institutes of Health (NIH) Call through the University of Cape Town (UCT) has been making strides in improving outcomes for these patients.
Professor Jonathan Peter, Head of the Division of Allergology and Clinical Immunology at Groote Schuur Hospital mentioned that in the last month, the project team has had two high-impact successes. Firstly, the recently published data in The Journal of Allergy and Clinical Immunology: In Practice, describing the novel use of a sequential drug allergy challenge in helping to reinitiate first-line TB drugs in patients hospitalised with SCARS.
Prof Peter said, “The multidisciplinary drug allergy clinic is the first of its kind on the continent and was started in 2016 with inputs from dermatology, infectious diseases, allergy, and pharmacology. Nested within this clinic is the immune-mediated adverse reactions in Africa patient registry and biorepository. The results of the study are globally unique, and we highlight the heterogeneity of these reactions and our experience.”
Secondly, a collaborative study was also published in the Nature Communications journal, which is the first detailed single-cell atlas of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). This work highlighted that across different drugs and diverse populations, there are several shared immune mechanisms that drive this SCAR. This paper will serve as an important reference for the better design of future diagnostics, preventative strategies and therapeutics going forward.
“Given that our work falls in the sphere of drug hypersensitivity amongst TB HIV co-infected patients, these recent outputs mark an important contribution to this field and are of high relevance to our HIV community given the use of common drugs like cotrimoxazole (Bactrim) and first-line anti-TB drugs”, concluded Prof Peter.
The SAMRC is the largest local funder of health research, medical diagnostics, medical devices, and therapeutics and remains committed to acquiring evidence-based information to inform health policy and practice that ultimately improves the quality and health status of all people in South Africa.