Elevation of IgE in HIV-infected subjects: A marker of poor prognosis

The IgE synthesis is tightly controlled by a complex network of T and B cells. Because human immunodeficiency virus (HIV) disease associates T cell activation and depletion, polyclonal B cell activation, atopic symptoms, drug hypersensitity, and autoimmune activity, we have evaluated IgE, as well as IgA, IgG, and igM, in 315 HIV-seropositive individuals with or without acquired immunodeficiency syndrome (AIDS) and compared the results to those of 100 HIV-seronegative subjects. IgE levels were higher in HIV-infected subjects as a whole, compared to levels in seronegative control subjects ( p p p 300/μl). In addition, we assessed the predictive value of IgE elevation over disease progression: in subjects with a CD4 count 150 KIU/L versus 44% in individuals with IgE p =0.016). In subjects with an AIDS-related complex, IgE>150 indicated a 100% rate of AIDS versus 9% in individuals with IgE p =0.003). Thus, IgE levels appear to be a very discriminative marker between patients in late stages of HIV infection. IgA, IgG, and IgM also significantly increased during HIV infection; the slope of their increase was, however, significantly less steep than that of IgE, suggesting different mechanisms of hyperproduction. Hypotheses regarding these mechanisms are discussed.