ALLERGY IN HIV-INFECTED PATIENTS (ON THE EXAMPLE OF CLINICAL OBSERVATION)

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 The study of allergy manifestations in HIV patients is an urgent problem of modern medicine. People with HIV have a high level of allergy manifestations.  Various studies also show that people infected with HIV have a high percentage of positive results in skin allergy testing compared to people without HIV infection[1, 2, 3, 4, 5, 6]. With HIV, there is an increase in asthma symptoms.  HIV patients have manifestations of allergic urticaria, atopic dermatitis, allergic rhinitis and bronchial asthma [4, 7].

These studies show that people with HIV infection are particularly susceptible to the irritating effects of tobacco smoke[1, 2, 3]. 

These problems are not an indication to delay or avoid HIV treatment. HIV is a deadly disease if left untreated, but wheezing and other asthma symptoms can be managed. More research is needed to better understand the relationship between HIV treatment and asthma symptoms[4].

The purpose of the study: To demonstrate the transformation of allergic diseases in a patient with HIV infection.

Materials and methods: Outpatient cards of the polyclinic, outpatient cards of the clinics "Victory" and "Aurora" of the city of Yakutsk from 2013 to 2023.

Patient C, 35 years old, was under dispensary supervision at the Victory Clinic from 2013 to 2015 with manifestations of skin allergies. According to the results of allergy testing in 2013, the patient was found to be allergic to milk +++.   In the general blood test from 04/5/2013: hemoglobin (HGB) – 120 g/l (RI: 115 - 145 g/l); erythrocytes (RBC) - 4.37x1012/l (RI: 3.7-4.9x1012/l); platelets (PLT) - 350 109/l (RI: 150 – 400x109/l); leukocytes (WBC) -11.8 x 109/l (RI: 5.5 – 14.5 x 109/l); lymphocytes (LYMF) – 29.1% (RI 19-37%); monocytes - 0.4 x 109/l (RI: 0.05 - 0.4 x 109/l); rod-shaped neutrophils - 2% (RI: 1-6%); segmented neutrophils - 60% (RI: 32-55%); eosinophils - 9% (RI: 0-5%); Panchenkov ESR determination -11 mm/h (RI: 1-15 mm/h). Conclusion of the analysis: An increase in the level of eosinophils.

Immunogram results: immunoglobulin A -0.9 g/l (RI: 0.7- 3.0 g/l); immunoglobulin M – 1.2 mg/ml (RI: 0.6-2.00 mg/ml); immunoglobulin G - 15.2 mg/ml (RI: 8.00-16.26 mg/ml); immunoglobulin E - 122 UNITS/ml (RI: 0-100Ed/ml); CD3+ 65.00% (RI: 62.0-69.0%); CD4+35.00% (RI: 28.1-65.0%); CD8+27.00% (RI: 26.0-68.0%). Conclusion of the analysis: There is an increase in immunoglobulin E.

Biochemical blood test from 09/5/2023:  alanine aminotransferase 10.3 u/L (RI: 00-29.00 u/L), aspartate aminotransferase 29.4 u/L (RI:00-36 u/L), albumin 35.5 g/L (RI: 38.00-54.00 g/L), total bilirubin 9.00 mmol/L (RI: 3.4-7.1 mmol/l), ferritin 9.77 mcg/L (RI: 7.00-140.00 mcg/L), phosphorus 1.67mmol/L (RI: 1.46-1.78 mmol/L), total protein 68.9 g/L (RI: 60.00-80.00 g/L), urea 5.8 mmol/L (RI: 1.8-6.4mmol/L), glucose 3.08mmol/L (RI: 3.3-5.6 mmol/L), iron 9.7 mmol/L (RI: 8.95-21.48mmol/L), total calcium 2.4 mmol/L (RI: 2.2-2.7 mmol/l). Conclusion: decrease in blood albumin content.

      Over the next four years, the patient received therapy for exacerbation of atopic dermatitis, followed a diet with the exception of dairy products and beef. The patient's condition could be assessed as satisfactory, relapses of atopic dermatitis were noted 2 times after dietary violations. In 2017, after unprotected contact, the patient noticed: weakness, weight loss, dry skin and enlarged peripheral lymph nodes.   In June 2017, the patient turned to the district pediatrician, who prescribed a referral for a general blood and urine test, a blood test for AIDS and hepatitis. As a result of the examination, the patient was diagnosed with HIV infection. The patient was examined and treated in the AIDS center of the city of Yakutsk. Since August 2027, the patient has been worried about nasal congestion, sneezing, watery eyes, and headaches.

  In early September 2017, the patient turned to an allergist-immunologist. An examination was conducted: a blood test was taken for allergoscreen panel No. 1 and an immunogram, rhinocytogram.

The following results were obtained: according to allergoscreen No. 1, allergy to birch 3.0, milk 3.2, wheat flour 2.8. rhinocytogram data from 09/28/2017 neutrophils 67 in n/a, eosinophils 10 in n/a.

Immunogram results: immunoglobulin A -0.9 g/l (RI: 0.7- 3.0 g/l); immunoglobulin M – 1.2 mg/ml (RI: 0.6-2.00 mg/ml); immunoglobulin G - 15.2 mg/ml (RI: 8.00-16.26 mg/ml); immunoglobulin E - 252 UNITS/ml (RI: 0-100Ed/ml); CD3+ 65.00% (RI: 62.0-69.0%); CD4+25.00% (RI: 28.1-65.0%); CD8+27.00% (RI: 26.0-68.0%). Conclusion: Reduction of CD4 subpopulation+25.00%.

Over the next two years, the patient followed a diet with the exception of wheat flour, dairy products, stone fruits, honey, nuts, etc.

During 2018-2020, the patient suffered from manifestations of allergic rhinitis and conjunctivitis in spring and autumn. She received nasonex (avamis) and singlon therapy at a dose of 10 mg per day for 3 days twice a year (spring and summer).

 In 2021, during the flu pandemic, the patient received a vaccination against COVID19 infection. A day after receiving the vaccine, the patient developed shortness of breath when walking, difficulty breathing.  The pulmonologist prescribed an examination: determination of total immunoglobulin E and spirometry. According to the results of the examination, the level of immunoglobulin E 1670 IU /ml was revealed, as well as the conclusion of spirometry: A violation of ventilation according to the restrictive type. OFV1 is reduced to 30% of the value. The test with bronchodilators is positive. The patient was diagnosed with bronchial asthma. The atopic form. Moderate severity. Aggravation.  Treatment was prescribed: Symbicort 4.5/160 2 times a day for 6 months, then montelar 10mg 1 tablet at night for 3 months.

In 2022, against the background of a violation of the diet, the patient ate a honey cake and drank wine at the celebration, rashes like urticaria and swelling of the lips and ears were noted. The patient was diagnosed with L50.0 Allergic urticaria. Quincke's edema. The patient received intravenous drops of dexamethasone 4mg, suprastinex 1 tablet overnight for up to 10 days, polysorb 1 tablespoon 3 times a day for 10 days. On the second day, the patient felt better - the swelling subsided.

    Thus,         People infected with the human immunodeficiency virus (HIV) have high levels of allergic conditions, including allergic rhinitis (hay fever), drug allergies and asthma. The HIV virus infects and destroys CD4+ T cells, which leads to a change in immune function, which contributes to the development of allergies, infections, cancer and other immune problems.

      Conclusions:1. In a patient with HIV infection, after the pathology is detected, the formation of allergic diseases is observed.

The formation of allergopathology in HIV patients is associated with a reduced level of CD4+ cells, which is one of the factors contributing to the development of allergy transformation.
The treatment of allergic diseases: bronchial asthma, atopic dermatitis, allergic rhinitis and allergic urticaria in patients with HIV is the same as in patients not infected with HIV. Oral administration of glucocorticosteroids should be avoided due to the immunosuppressive effects of this group of drugs.

About the authors

Olga Ivanova

Northeastern Federal University named after M.K.Ammosov

Author for correspondence.
Email: olgadoctor@list.ru
ORCID iD: 0000-0001-5210-0220

MD,  Professor department of Pediatrics and Pediatric Surgery, mainly freelance allergist-immunologist of the Ministry of Health of the Republic of Sakha (Yakutia), member of the Russian Academy of Natural Sciences, the Union of Pediatricians of Russia, the Russian Association of Allergists and Subsequent Immunologists

Russian Federation

Irina Semenovna Ivanova

NORTH-EASTERN FEDERAL UNIVERSITY

Email: motherolga1969@mail.ru
ORCID iD: 0000-0002-2579-4690

4th year student of LD

Russian Federation, 677000Yakutsk, ul.Belinsky 58

References

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