IMMUNOLOGICAL ASPECTS OF HYPERIMMUNOGLOBULINEMIA E-LIKE SYNDROME IN PATIENTS WITH AIDS

In this study we describe a series of nine patients affected by acquir ed immunodeficiency syndrome (AIDS) or AIDS-related complex who had hy pereosinophilia and hyperimmunoglobulinemia E (hyper-IgE) with chronic dermatitis and recurrent staphylococcal infections. These patients ha d features similar to those present in hyper-IgE syndrome, a primary i mmunodeficiency disease. In addition, immunologic characterization of these patients with human immunodeficiency virus (HIV) infection, comp ared with 51 HIV-positive patients without hyper-IgE, both atopic and nonatopic, and three patients affected by the primary hyper-IgE syndro me also revealed art increase in IgA and a severe decrease in B and CD 4+ lymphocytes. Spontaneous in vitro synthesis of IgE by peripheral bl ood mononuclear cells was confirmed in both hyper-IgE conditions toget her with increased levels of circulating eosinophil cationic protein. Serum-soluble CD23, usually increased in atopic conditions and hyper-I gE, was similar to that of normal control subjects in the HIV-positive patients with hyper-IgE. On the basis of our findings, we conclude th at a hyper-Ige-like syndrome represents a distinct aspect of the clini cal manifestations associated with HIV infection and that the immunolo gic mechanisms in this condition seem to differ from those known in pr imary hyper-IgE syndrome, because. CD4+ T-H2 type cells, which are cur rently believed to have a role in IgE production, are severely deplete d in HN-positive patients.