Long term recovery of IgG and IgM production during HIV infection in a patient with common variable immunodeficiency (CVID)

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.