Allergen immunotherapy in a patient with human immunodeficiency virus: effect on T-cell activation and viral replication.
BACKGROUND
Allergen immunotherapy is a major therapeutic modality in the treatment of allergic rhinitis. However, with T-cell activation potential, its role in patients with human immunodeficiency virus (HIV) was theoretically limited.


OBJECTIVE
To report the results of allergen immunotherapy in a patient with HIV treated with highly active antiretroviral therapy (HAART).


METHODS
A 44-year-old man with a history of HIV did not respond to medical therapy for allergic rhinitis. His HIV status was well controlled with HAART. Owing to the severity of his allergic rhinitis symptoms, he accepted the risk of allergy immunotherapy despite the unknown effect of immunotherapy in patients with HIV.


RESULTS
After 6 weeks of weekly immunotherapy injections, his viral load remained undetectable and his CD4 cell count changed from 540 to 570 cells/microL. After 16 weeks of weekly immunotherapy, his viral load increased to 10,900 copies/mL, and his CD4 cell count increased to 665 cells/microL. After 24 weeks of weekly immunotherapy, his viral load returned to an undetectable level, and his CD4 cell count stabilized at 356 cells/microL. Despite his notable change in HIV status, he continues to receive the same HAART. He currently continues en route to maintenance immunotherapy.


CONCLUSIONS
The effect of allergen immunotherapy on HIV infection has not been previously reported. A concern remains that any form of immunotherapy may negatively affect HIV disease progression. This case illustrates that weekly allergen immunotherapy may have induced limited T-cell proliferation and a modest increase in RNA viral load, which resolved with continuation of HAART.
Randhawa
Inderpal Singh
IS
UCLA West Los Angeles VA Medical Center, Los Angeles, California 90073, USA. docrandhawa@yahoo.com
Junaid
Imran
I
Klaustermeyer
William B
WB
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003888:Desensitization, Immunologic; D015658:HIV Infections / Q000276:immunology* / Q000821:virology; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology / Q000628:therapy*; D013601:T-Lymphocytes / Q000276:immunology*; D014779:Virus Replication