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HIV CVID/IGA
Jun 1, 2008

Dr Bob, I just discovered your site while looking for infoo regarding what effect IGA deficiency may have on my risk of developing HIV. I've lead a very sheltered life up until recently. At the ageof 48, I have started some risky behaviors. Mostly oral sex with other men. I always thought it was low risk, but recently heard that my complete lack of IGA may increase my risk of infection significantly. Now that the horse is out of the barn, I'm worried. What can you tell me about IGA deficiency and HIV? I'll bet I wouldn't last long after infection with this disorder, even with medication. I have been tested several times fir IGA, and none was detected. I have a history of severe respiratory and digestive infections, but always tested HIV neg. I'm also a celiac, and lost about 9" of my colon 6 years ago, and had a temporary colostomy. Please tell me anything you can.

Response from Dr. Frascino

Hi,

First off, CVID (common variable immunodeficiency disease) and selective IgA deficiency are two different immunological conditions.

Regarding CVID, since this condition is "variable" from person to person and can involve deficiency in immunoglobulin production, it is possible tests that rely on detection of specific antibodies (immunoglobulins) may be affected by the condition and therefore not be accurate. These tests would include HIV-antibody tests (ELISA, EIA, rapid tests). Therefore using non-antibody dependent tests, such as a HIV DNA PCR qualitative test may be necessary to assess HIV serostatus. Hopefully you are being followed by a board certified clinical immunologist for your selective IgA deficiency. (If not, you should be.) The clinical immunologist should be able to review your laboratory test results and advise you regarding which HIV test would be warranted if indeed you had CVID in addition to selective IgA deficiency.

If you have selective IgA disease exclusively, HIV-antibody test results would most likely not be compromised, because they would involve primarily other immunoglobulins (IgG).

As for IgA deficiency and concurrent HIV disease, as you may well know, selective IgA deficiency is one of the most common primary immunodeficiency diseases. The exact cause or causes remain unknown. Many folks with selective IgA deficiency appear healthy or have relatively mild illnesses, while others can have very significant problems. Some folks with selective IgA deficiency may have IgG2 or IgG4 subclass deficiency, which may make them more susceptible to infections.

IgA primarily protects mucosal surfaces. Consequently, those with selective deficiencies may have problems with recurrent ear infections, sinusitis, bronchitis, pneumonia and gastrointestinal infections. Another major problem in folks with selective IgA deficiency is an increased incidence of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, immune thrombocytopenia purpura (ITP), etc.).

If a person with selective IgA deficiency were to become HIV positive, their clinical course could be complicated by these conditions.

My best advice to you is not to become infected! Use latex condoms for all penetrative sex! Also you should be followed routinely by a clinical immunologist with experience managing selective IgA deficiency.

Good luck.

Dr. Bob



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