Intractable pruritus in HIV infection: immunologic characterization

Background: Severe, intractable pruritus, often associated with erythematop apular skin lesions and hypereosinophilia, is a condition observed in some nonatopic, HIV-infected patients. We performed immunovirologic analyses of this condition. Methods: Immunologic (mitogen-stimulated production of cytokines, tumor nec rosis factor-alpha [TNF-alpha], and soluble CD23; serum levels of soluble C D23, ICAM-1, TNF-alpha, IgG, IgE, and IgA) and virologic (HIV viral load) p arameters were analyzed in six patients with therapy-resistant pruritus. Hy pereosinophilia was present in all these patients. Results were compared to those of seven HIV-seropositive individuals similar to the first one in te rms of CD4 counts and clinical staging, but without pruritus. Results: Hypereosinophilia; hyper-IgE arid hyper-IgA; augmented interleukin (IL)-4, IL-5, and sCD23; and reduced interferon-gamma production by mitoge n-stimulated peripheral blood mononuclear cells (PBMC) were detected when p atients with pruritus were compared to HIV controls. HIV viral load was als o augmented in patients in whom pruritus was present. Conclusions: The results suggest that therapy-resistant, intractable prurit us accompanied by hypereosinophilia may be used to define a subset of HIV-s eropositive individuals showing prototypic hyperactivation of humoral immun ity, and in whom augmented HIV viral load is present.