Pivotal role of HIV and EBV replication in the long-term persistence of monoclonal gammopathy in patients on antiretroviral therapy

Blood. 2013 Oct 24;122(17):3030-3. doi: 10.1182/blood-2012-12-470393. Epub 2013 Aug 12.

Abstract

A high prevalence of monoclonal gammopathy (MG) has been observed in HIV-infected patients. We explored the conditions associated with long-term persistence of serum monoclonal protein (M protein) in HIV-infected patients on antiretroviral therapy (ART). Of 21 patients with MG, M protein disappeared in 12 patients (58%) over 5 years of ART. Higher level of serum γ-globulin and higher percentages of circulating plasmablasts and plasma cells were observed in patients with persistent MG compared with patients with transient MG. MG persistence was associated with the cumulative time of detectable plasma HIV RNA after ART initiation, detection of Epstein-Barr virus (EBV) DNA in plasma, and a high level of EBV DNA in B cells. Poor control of HIV replication and detectable EBV replication in plasma were both associated with long-term MG persistence in patients on ART. In the case of viral control, MG associated with HIV infection is usually transient.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active*
  • Coinfection
  • DNA, Viral / antagonists & inhibitors*
  • Epstein-Barr Virus Infections / drug therapy*
  • Epstein-Barr Virus Infections / immunology
  • Epstein-Barr Virus Infections / virology
  • Female
  • Glycoproteins / blood
  • Glycoproteins / genetics
  • Glycoproteins / immunology
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • HIV Infections / virology
  • HIV-1 / immunology
  • Herpesvirus 4, Human / immunology
  • Humans
  • Male
  • Middle Aged
  • Paraproteinemias / drug therapy*
  • Paraproteinemias / immunology
  • Paraproteinemias / virology
  • Plasma Cells / drug effects
  • Plasma Cells / immunology
  • Plasma Cells / virology
  • Time Factors
  • Viral Load / drug effects
  • Virus Replication / drug effects*
  • gamma-Globulins / genetics
  • gamma-Globulins / immunology

Substances

  • Anti-Retroviral Agents
  • DNA, Viral
  • Glycoproteins
  • gamma-Globulins
  • protein M (glycoprotein)