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Recurrent Pneumonia HIV Immunoglobulins — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostRecurrent Pneumonia HIV ImmunoglobulinsSCE Infectious Diseases

A 35-year-old woman with HIV on ART develops recurrent bacterial pneumonia (3 episodes in 12 months). CD4 is 580, VL <50. She is a non-smoker. All pneumonias resolved with standard antibiotics. What investigation should be considered?

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Correct answer: B — Immunoglobulin levels — recurrent bacterial infections despite adequate CD4 in HIV may indicate persistent B-cell dysfunction or hypogammaglobulinaemia (which occurs more commonly in PLWH than the general population)

Recurrent bacterial infections in well-controlled HIV with normal CD4 should prompt investigation for: (1) immunoglobulin deficiency (IgG subclass deficiency and hypogammaglobulinaemia are more common in PLWH), (2) bronchiectasis (CT thorax), (3) underlying lung disease, (4) functional antibody responses. If hypogammaglobulinaemia is confirmed, immunoglobulin replacement therapy may be indicated.

Reference: BHIVA 2022 – Immunodeficiency in HIV; NICE 2024 – Primary immunodeficiency