ANGIOEDEMA AND HIV INFECTION

Background: The rate of HIV infection is rising in Portugal, with values significantly higher than the average for Western Europe. Although cutaneous involvement is very frequent in HIV patients, descriptions of angioedema are rare in these patient. Aim: To retrospectively characterise and evaluate the number of HIV positive patients admitted to our allergy and clinical immunology department for angioedema ? Methods: We analysed data on 145 admissions (141 patients to our allergy and clinical immunology department between January 2005 and July 2006. Results: During this 19-month period, 51% of admissions were due to cutaneous symptoms, 80% of which were angioedema. HIV infection was found in six of the 54 patients admitted for angioedema (11%), two of them having recurrent angioedema. All HIV patients presented polyclonal hypergammaglobulinaemia. There was no previous HIV diagnosis in there of the six patients and only one had risk factors for HIV infection. Five of the six angioedema HIV positive patients presented very high viral loads and/or CD4 counts below 200/μL. No alterations in serum complement values were observed that could correspond to a significant consumption. In the follow-up phase on these patients (mean 18 months), improvements were observed in CD4 counts and/or in viral loads. Additionally, no further angioedama episodes occurred. Conclusions: Our study demonstrates a nigher than experted number of patients with HIV among angioedem admissions to an Immunoallergology department and the consequent need to be on the alert for this infection. The presence of polyclonal hypergammaglobulinaemia should always prompt clinical suspicion of HIV infection, even in the absence of risk factors. The physiopathological link between HIV infection and angioedema is not clear, ear as, similarly to other authors, we could not detect any significant complement consumption in out patients. However, there is a clear clinical association between affective antiretroviral therapy and absence of further angioedama episodes in patients with recurrent angioedema.