Residual immune dysregulation in human immunodeficiency virus infection: implications for hypersensitivity

Residual immune dysregulation persists in people living with human immunodeficiency virus (PLWHIV) despite antiretroviral therapy (ART), characterized by chronic immune activation and imbalances in immune responses that increase the risk of allergic conditions such as drug hypersensitivity, atopic dermatitis (AD), and asthma. This literature review explores the mechanisms underlying immune dysregulation in PLWHIV and its implications for hypersensitivity reactions. HIV infection shifts the immune response from Th1 to Th2, increasing cytokine production, particularly IL-4 and IL-13, and elevating IgE levels, contributing to allergic reactions. Drug hypersensitivity, especially to nevirapine and abacavir, occurs more frequently in PLWHIV, with a higher risk of severe conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The management of allergies in PLWHIV remains challenging due to persistent immune dysregulation, limited therapeutic options, and the lack of specific clinical guidelines. Understanding these immunological changes is crucial for developing better strategies for allergy prevention and management in this population.