ELEVATION OF IGE IN HIV-INFECTED CHILDREN AND ITS CORRELATION WITH THE PROGRESSION OF DISEASE

Background: According to recent data, a switch from a T-H1 to a T-H2 p attern of cytokines might be a critical step in the progression of hum an immunodeficiency virus (HN) infection. Previous studies have demons trated a disturbance in IgE synthesis in HIV-infected adults. Methods: Fifty-eight children infected vertically with HN and 35 children with seroreversion, aged 4 months to 11 years, were evaluated for IgE seru m level, CD4(+) cell count, skin prick test responses to common airbor ne and food allergens individual and family history of atopy, and pres ence of opportunistic infections. In thirty of the 58 HIV-infected chi ldren serum interleukin-4 and interferon-gamma levels were assessed. T hirty-three of the 58 HIV-infected children had a follow-up of 1 year for IgE levels, CD4(+) cell count, and occurrence of opportunistic inf ections and recurrent bacterial infections. Results: Both IgE concentr ation and the percentage of children with IgE elevation were markedly increased (with no correlation to skin prick test responses or opportu nistic infections) in the group of 58 HIV-infected children as compare d with the 35 children with seroreversion (p < 0.05). The same paramet ers were higher in children with acquired immunodeficiency syndrome as compared with children with asymptomatic or mildly symptomatic diseas e (p < 0.05). Serum interleukin-4 and interferon-gamma levels do not a ccount for IgE hyperproduction. There was a significant association be tween persistent IgE elevation and severe decline (greater than or equ al to 30% over 1 year) in CD4(+) counts, as well as increased suscepti bility to bacterial infections. Conclusions: Our study demonstrates a spectrum of IgE dysfunction in children, which is similar to that obse rved in adults. A persistent IgE hyperproduction appears to be associa ted with a severe decline in CD4(+) cell count, suggesting that this c linical test is a useful marker of disease progression.