Immune-mediated adverse drug reactions (IM-ADRs) are significantly more common in HIV patients. Antiretroviral and antiinfective medications are common offenders, however the burden of individual medication IM-ADRs varies by demographic. This review looks at new research on the incidence, causes, clinical management, and prevention of IM-ADRs in people living with HIV/AIDS. With increasing use, IM-ADRs to integrate strand transfer inhibitors, both oral and injectable, have been recorded. The clinical spectrum and management of IM-ADRs in HIV-infected patients are comparable to those in the general population, with the exception of a recently described severe delayed efavirenz DILI with significant mortality. Furthermore, the environment can be distinct, as seen by lower-than-expected mortality in a Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from an HIV/TB high-burden setting.

The near-complete elimination of Abacavir drug hypersensitivity syndrome with the deployment of HLA-B57:01 screening is an illustration of how prevention is attainable with mechanistic insight. Because of the complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, drug provocation testing, treat-through, and desensitisation strategies must be used more frequently. Improved diagnostics and predictive biomarkers are urgently needed for prevention, as well as to guide treatment-through, rechallenge, and desensitisation techniques.

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