IgA deficiency associated with human immunodeficiency virus infection

CORRESPONDENCE

IgA deficiency associated with human immunodeficiency virus infection

In a survey of immunological alterations associated with human immunodeficiency virus (HIV) in 16 Brazilian women immediately after delivery, we found one with IgA deficiency.

The patient was a 27 year-old-woman who had just given birth to her second child, a boy with 3040g adequate for his gestational age. She reported having had multiple sexual partners, one of them was an intravenous drug abuser. She denied weight loss, persistent fever, recurrent diarrhoea, pneumonia or other kind of infection. Her physical examination showed nothing abnormal but a tattoo on her left inferior limb.

HIV infection was indicated by screening with the enzyme-linked immunosorbent assay (Abbott HIV-1 EIA recombinant), and confirmed by the Western Blot test (Biotech/Du Pont HIV-1). The quantitation of serum IgG, IgA was done by the single radial immunodifusion method (Behring), and showed the following results: 26.84 g/l for IgG, 1.70 g/l for IgM and <0.05 g/l for IgA. Other laboratory tests were not available, as she did not return for follow up.

According to the Centers for Disease Control Classification system for the HIV infection², she would be included in group II, that is, asymptomatic infection but already with immunological alterations, as noted by the elevated IgG.

Increased IgA concentration in asymptomatic HIV-infected subjects has been considered a predictor of evaluation towards AIDS^3,5 . On the other hand, the opposite situation, e.g., serum IgA deficiency, has also been detected associated to HIV infection in a few cases, in 2 children⁶ and 2 adults⁴. The superposition of two independent pathologic conditions that is, IgA deficiency and HIV infections, is one possibility⁴. In Brazil, in fact, a survey among 11576 healthy people¹ showed an incidence of IgA deficiency of 1 in 965. As another possibility, IgA deficiency could be a consequence of HIV infection⁶. This latter hypothesis is in accord with a recent study in which a healthy child acquired IgA deficiency following an Epstein-Barr virus infection⁷.

Prospective analysis of serum immunoglobulins in high-risk groups may help to evaluate the potential effects of primary IgA deficiency on the evaluation of HIV infection , as well as the possible incidence and importance of IgA deficiency secondary to HIV infection.

Department of Paediatrics -
Escola Paulista de Medicina
R. Napoleão de Barros, 715 - 9º andar
FAX:[phone]
São Paulo, BRAZIL
Department of Clinical Immunology

Maria Isabel de MORAES-PINTO

Calil Kairalla FARHAT

University of Goteborg
Goteborg, SWEDEN Lars A. HANSON Department of Immunology
Universidade de São Paulo
São Paulo, BRAZIL Solange Barros CARBONARE
Magda Maria Sales CARNEIRO-SAMPAIO

REFERENCES

1. CARNEIRO-SAMPAIO, M.M.S.; CARBONARE, S.B.; ROZENTRAUB, R.B.; ARAÚJO M.N.T.; RIBEIRO, M.A. & PORTO, M.H.O. - Frequency of selective IgA deficiency among Brazilian blood donors and healthy pregnant women. Allergol. Immunopath., 17: 213-216, 1989.

2. CENTERS for Disease Control - Classification system form human T-lymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR, 35: 334-339, 1986.

3. FLING, J.A.; FISCHER, J.R. BOSWELL, R.N. & REID, M.J. - The relationship of serum IgA concentration to human immunodeficiency virus (HIV) infection: a cross-sectional study of HIV-seropositive individuals detected by screening in the United States Air Force. J. Allergy clin. Immunol., 82: 965-970, 1988.

4. HEPNER, M.; JUNDT, J.; FISHER, E. & OWNBY, D.R. - IgA deficiency and AIDS. J. Amer. med. Ass., 254: 912, 1985.

5. LEFRERE, J.J.; FINE, J.M.; LAMBIN, P.; SALMON, D. & SALMON, C. - Increased IgA as a predictor of development of AIDS in HIV-infected subjects. Clin. Chem., 34: 1356, 1988.

6. NADAL, D.; HUNZIGER, U.A.; SCHÜPBACH, J.; WETZEL, J.C.; TOMASIK, Z.; JENDIS, J.B.; FANCONI, A. & SEGER, R.A. - Immunological evaluation in the early diagnosis of prenatal or perinatal HIV infection. Arch. Dis. Childh., 64: 662-669, 1989.

7. SAULSBURY, F.T. - Selective IgA deficiency temporarily associated with Epstein-Barr virus infection. J. Pediat., 115: 268-270, 1989.

Recebido para publicação em 25/11/1992

Aceito para publicação em 12/2/1993

Publication Dates

• Publication in this collection
  28 July 2006
• Date of issue
  Apr 1993