ELEVATION OF IGE IN HIV-INFECTED SUBJECTS - A MARKER OF POOR PROGNOSIS

The IgE synthesis is tightly controlled by a complex network of T and B cells. Because human immunodeficiency virus (HIV) disease associates T cell activation and depletion, polyclonal B cell activation, atopic symptoms, drug hypersensitivity, and autoimmune activity, we have evaluated IgE, as well as IgA, IgG, and IgM, in 315 HIV-seropositive individuals with or without acquired immunodeficiency syndrome (AIDS) and compared the results to those of 100 HIV-seronegative subjects. IgE levels were higher in HIV-infected subjects as a whole, compared to levels in seronegative control subjects (p < 0.05). This difference was particularly marked between patients with AIDS and control subjects (p < 0.005). A strong relationship appeared between IgE and the immune status as assessed by CD4 cell counts (p < 0.001 between IgE values in patients with CD4 < 300 or > 300/mu-l). In addition, we assessed the predictive value of IgE elevation over disease progression: in subjects with a CD4 count < 300/mu-l, the survival analysis disclosed a 24-month occurrence rate of AIDS of 83% in individuals with IgE > 150 KIU/L versus 44% in individuals with IgE < 150 (p = 0.016). In subjects with an AIDS-related complex, IgE > 150 indicated a 100% rate of AIDS versus 9% in individuals with IgE < 150 (p = 0.003). Thus, IgE levels appear to be a very discriminative marker between patients in late stages of HIV infection. IgA, IgG, and IgM also significantly increased during HIV infection; the slope of their increase was, however, significantly less steep than that of IgE, suggesting different mechanisms of hyperproduction. Hypotheses regarding these mechanisms are discussed.