AIDS, HIV-positive patients, and allergies

HIV is a disease that attacks the central control mechanisms of the immune response, yielding a condition that results in opportunistic infections, malignancies, and death. Yet, in many HIV+ patients, the morbidity from immune-based hypersensitivity diseases is a major issue long before their immunodeficiency manifests itself clinically. A major manifestation of this hypersensitivity state is IgE-mediated conditions. The incidence of atopy is similar to HIV- counterparts except for drug sensitivities, which are significantly higher in this population. Clinical manifestations are similar and the therapeutic approach is the same as that for any other atopic patient. The use of allergen immunotherapy for allergic respiratory diseases in HIV+ patients is currently undergoing investigation. Data in pilot studies and case reports suggest AIT may be safe and effective in HIV+ patients, at least those with early and middle disease. The practicing allergist-immunologist should be aware of the likelihood of seeing HIV+ atopic patients in his or her practice and should be prepared to consider therapies to minimize morbidities and improve quality of life for these individuals whose life expectancies are continuing to improve with new antiretroviral therapy development.