Exploring the link between IgE-mediated inflammation and cardiorenal function in adults living with and without HIV

Abstract

Immunoglobulin E (IgE) is traditionally recognized for its role in allergic response. However, emerging evidence suggests it may also influence cardiovascular, renal, and immune function. Understanding how IgE relates to endothelial function, electrolytes, renal markers, inflammatory mediators, and sociodemographic factors could provide insight into integrated cardiorenal-immune pathways and inform risk stratification people living with or without HIV. This cross-sectional study included 221 adults (median age 49 years, 68.3% female, 64.7% HIV-positive) at the medical clinic of Livingstone University Teaching Hospital. We collected data on sociodemographic characteristics, and performed diagnostic assessments for cardiometabolic health and inflammatory markers, including total IgE. To identify factors independently associated with IgE levels, we employed multiple linear regression models. Given the potential for HIV to modulate immune responses, all analyses were adjusted for relevant confounders, with statistical significance set at p < 0.05. In multivariable analysis of the overall cohort, log-transformed IgE levels were independently associated with serum creatinine (β = 2.26, 95% CI: 0.80–3.73, p = 0.003), plasma chloride (β = 0.11, 95% CI: 0.02–0.21, p = 0.020), flow-mediated dilation (FMD) (β = 0.03, 95% CI: 0.001–0.066, p = 0.043), and peripheral neuropathy (β = 0.81, 95% CI: 0.16–1.45, p = 0.014). However, after false discovery rate (FDR) correction, only serum creatinine remained significantly associated with IgE. In analyses restricted to people living with HIV, several factors remained independently associated with IgE after FDR adjustment, including serum creatinine (β = 2.71, 95% CI: 1.45–3.97, p < 0.001), plasma chloride (β = 0.14, 95% CI: 0.05–0.23, p = 0.003), salt taste preference (β = 0.25, 95% CI: 0.09–0.41, p = 0.003), and FMD (β = 0.04, 95% CI: 0.01–0.07, p = 0.011). Aldosterone demonstrated an inverse association with IgE (β = −1.22, 95% CI: −2.16 to − 0.27, p = 0.013). Other associations, including inflammatory and hematologic markers, were attenuated after correction for multiple testing. IgE levels in this HIV-endemic cohort were most consistently associated with renal function, with serum creatinine emerging as the only robust correlate after multiple testing correction. Additional associations with endothelial function, electrolytes, and behavioral factors were observed, particularly among people living with HIV, but remained exploratory. These findings suggest that IgE reflects a broader state of systemic immune activation rather than a specific driver of cardiorenal dysfunction. Longitudinal and mechanistic studies are needed to clarify causality and determine any prognostic relevance.