S. Jolles et al., Long term recovery of IgG and IgM production during HIV infection in a patient with common variable immunodeficiency (CVID), J CLIN PATH, 54(9), 2001, pp. 713-715
Citations number
12
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology","Medical Research Diagnosis & Treatment
Aims-Common variable immunodeficiency (CVID) is the most common serious pri
mary immunodeficiency. This paper describes the immunological consequences
of human immunodeficiency virus (HIV) infection in a patient with familial
CVID subsequently treated with highly active antiretroviral therapy (HAART)
.
Methods-Serial measurements over 11 years of serum immunoglobulins, specifi
c antibodies to tetanus toxoid and pneumococcal polysaccharides, lymphocyte
phenotypes, and HIV viral load were made.
Results-The patient recovered total serum IgG and IgM, but not IgA producti
on, with adequate concentrations of specific antibodies, allowing withdrawa
l of intravenous immunoglobulin without an increase in infections. T cell n
umbers gradually declined and the patient developed a high grade B cell lym
phoma. After successful chemotherapy, HAART was commenced, viral load fell
from 472 000 to < 50 copies/ml, and CD4(+) T cell numbers increased from 13
to 661 x 10(6)/litre. Antibody production was maintained after suppression
of viral load.
Conclusions-This is the first definitive report of reversal of IgG and IgM
deficiency in familial CVID after HIV infection. Failure to normalise IgA s
upports the concept of separate predisposing genetic factors for selective
IgA deficiency, which when combined with others lead to CVID. Furthermore,
a persistently high viraemia is not required to maintain the recovery of im
munoglobulin values, suggesting this depends either on a transitory effect
of a high viral load, or a persistence of low amounts of virus.