Cytokine profile of a long-term pediatric HIV survivor with hyper-IgE syndrome and a normal CD4(+) T-cell count

Background: An elevated IgE level and increased production of T-H2 cytokine s are factors associated with poor prognosis in HIV infection. We report a pediatric long-term survivor of vertically acquired HIV infection with a no rmal CD4 count and a lon viral burden despite the lack of antiretroviral th erapy and a phenotype resembling hyper-IgE syndrome. Objective: We sought to characterize the patient's T-H1 versus T-H2 cytokin e profile and anti-HIV-specific immune responses, Methods: Supernatants collected from cultures of peripheral blood T cells s timulated with phorbol myristate acetate plus ionomycin were assayed for T- H1 and T-H2 cytokines by means of ELISA. Specific IgE antibodies were deter mined by immunoblot, HIV-specific cytotoxic T-lymphocyte responses were mea sured from cell lysis by fresh T cells of autologous B-lymphoblastoid cells expressing recombinant AIV proteins. Results: Patient CD4(+) T cells secreted significantly more T-H2 cytokines. IL-4 (P < .003) and IL-5 (P < .03), than HIV-infected and seronegative con trol cells. No difference was noted in T-H1 cytokine production. IgE specif ic for HIV gp160, p24, p17, and p66 proteins and,Aspergillus fumigatus was detected in patient sera. Despite predominance of T-H2 cytokines, HIV-speci fic cytotoxic T-lymphocyte activity was vigorous, Conclusions: The patient demonstrated predominantly T-H2 cytokine productio n in vitro. Unlike other patients with HIV who have hyper-IgE and increased T-H2 cytokine production, our patient has maintained HIV-specific immune r esponses, a low viral load, and a normal CD4 count without antiretroviral t herapy. These findings support a diagnosis of primary hyper-IgE syndrome. P resence of anti-HIV-specific IgE may represent a protective mechanism again st HIV replication in our patient.