Original Article

Serum protein electrophoresis pattern in patients living with HIV: frequency of possible abnormalities in Iranian patients

Abstract

Background and Objectives: This prospective case-control study was conducted to evaluate abnormal serum protein electrophoresis (SPEP) patterns in patients living with human immunodeficiency virus (HIV) and its relation with disease severity markers and anti-retroviral treatment status.
Materials and Methods: Thirty-seven HIV-positive patients and 24 healthy individuals were evaluated in the course of this study. The healthy HIV-negative individuals were selected as control group. Pregnant women, patients with malignancies, children, hepatitis B- and/or C-positive patients, those with a history of an autoimmune disease, or previous corticosteroid administration were excluded. SPEP—which detects serum levels of albumin, total protein, gammaglobulin—, CD4+ T-cell counts, viral load, and antiretroviral treatment status were assessed. Data were analyzed by SPSS™ software.
Results: Twelve patients (32 percent) demonstrated polyclonal gammopathy on SPEP, while only 1 (4 percent) healthy individual had the same pattern (P-value = 0.007). No statistically significant connection between SPEP patterns and antiretroviral treatment status was observed (P-value > 0.05). Interestingly no statistically significant relationship between CD4+ T-cell counts and polyclonal gammopathy was discerned. No statistically significant difference was observed between the two groups with regards to serum albumin and total protein levels. The serum albumin to total protein percentage, serum gamma globulin to total protein percentage, and serum albumin to globulin ratio was compared between the groups and a statistically significant difference was observed.
Conclusion: Polyclonal gammopathy on SPEP is common among HIV-infected patients. Moreover, the SPEP patterns cannot be used as an indication of a patient’s negative or positive response to treatment.

1. Maartens G, Celum C, Lewin SRJTL. HIV infection: epidemiology, pathogenesis, treatment, and prevention. Lancet 2014;384:258-271.
2. Février M, Dorgham K, Rebollo AJV. CD4+ T cell depletion in human immunodeficiency virus (HIV) infection: role of apoptosis. Viruses 2011;3:586-612.
3. Haas A, Zimmermann K, Oxenius A. Antigen-dependent and -independent mechanisms of T and B cell hyperactivation during chronic HIV-1 infection. J Virol 2011;85:12102-12113.
4. Younas M, Psomas C, Reynes J, Corbeau P. Immune activation in the course of HIV-1 infection: Causes, phenotypes and persistence under therapy. HIV Med 2016;17:89-105.
5. Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med 1983;309:453-458.
6. De Milito A, Nilsson A, Titanji K, Thorstensson R, Reizenstein E, Narita M, et al. Mechanisms of hypergammaglobulinemia and impaired antigen-specific humoral immunity in HIV-1 infection. Blood 2004;103:2180-2186.
7. Nilssen DE, Oktedalen O, Brandtzaeg P. Intestinal B cell hyperactivity in AIDS is controlled by highly active antiretroviral therapy. Gut 2004;53:487-493.
8. Shirai A, Cosentino M, Leitman-Klinman SF, Klinman DM. Human immunodeficiency virus infection induces both polyclonal and virus-specific B cell activation. J Clin Invest 1992;89:561-566.
9. Moir S, Fauci AS. B cells in HIV infection and disease. Nat Rev Immunol 2009;9:235-245.
10. Konstantinopoulos PA, Dezube BJ, Pantanowitz L, Horowitz GL, Beckwith BA. Protein electrophoresis and immunoglobulin analysis in HIV-infected patients. Am J Clin Pathol 2007;128:596-603.
11. Redgrave BE, Stone SF, French MA, Krueger R, James IR, Price P. The effect of combination antiretroviral therapy on CD5 B- cells, B-cell activation and hypergammaglobulinaemia in HIV-1-infected patients. HIV Med 2005;6:307-312.
12. Cagigi A, Nilsson A, De Milito A, Chiodi F. B cell immunopathology during HIV-1 infection: lessons to learn for HIV-1 vaccine design. Vaccine 2008;26:3016-3025.
13. Nagase H, Agematsu K, Kitano K, Takamoto M, Okubo Y, Komiyama A, et al. Mechanism of hypergammaglobulinemia by HIV infection: circulating memory B-cell reduction with plasmacytosis. Clin Immunol 2001;100:250-259.
14. Coker WJ, Jeter A, Schade H, Kang Y. Plasma cell disorders in HIV-infected patients: epidemiology and molecular mechanisms. Biomark Res 2013;1:8.
15. Amara S, Dezube BJ, Cooley TP, Pantanowitz L, Aboulafia DMJCid. HIV-associated monoclonal gammopathy: a retrospective analysis of 25 patients. Clin Infect Dis 2006;43:1198-1205.
16. Centers for Disease Control and Prevention (CDC). National HIV testing day and new testing recommendations. MMWR Morb Mortal Wkly Rep 2014; 63:537.
17. Zemlin AE, Ipp H, Maleka S, Erasmus RT. Serum protein electrophoresis patterns in human immunodeficiency virus-infected individuals not on antiretroviral treatment. Ann Clin Biochem 2015;52:346-351.
18. Adedeji AL, Adenikinju RO, Ajele JO, Olawoye TL. Serum protein electrophoresis under effective control of HIV-1 disease progression. EXCLI J 2014;13:761-771.
19. van Vuuren MJ, Zemlin AE, Germishuys JJ. Monoclonal gammopathy and other serum protein electrophoresis patterns in patients with HIV infection in South Africa. Ann Clin Biochem 2010;47:366-374.
20. Sarro YS, Tounkara A, Tangara E, Guindo O, White HL, Chamot E, et al. Serum protein electrophoresis: any role in monitoring for antiretroviral therapy? Afr Health Sci 2010;10:138-143.
21. Casanova ML, Makinson A, Eymard-Duvernay S, Ouedraogo DE, Badiou S, Reynes J, et al. Monoclonal gammopathy in HIV-1-infected patients: factors associated with disappearance under long-term antiretroviral therapy. J Acquir Immune Defic Syndr 2015; 70:250-255.
22. Soong J, Riley R, Mcpherson R. Oligoclonal bands of Immunoglobulins in serum leading to diagnosis of human immunodeficiency virus 1 infection. Am J Clin Pathol 2016; 145:277-281.
23. Salarieh A, Rao C, Gottesman SR, Alagha O, Todor R, Axiotis CA. Plasma cell tumors in HIV-positive patients: report of a case and review of the literature. Leuk Lymphoma 2005;46:1067-1074.
24. Jou E, Gligich O, Chan AC, Mohan D, Felsen UR, Ayyappan S, et al. Retrospective study of the prevalence and progression of monoclonal gammopathy in HIV positive versus IV negative patients. Hematol Oncol 2017;35:64-68.
25. Blade J, Kyle RA. Multiple myeloma in young patients: clinical presentation and treatment approach. Leuk Lymphoma 1998;30:493-501.
Files
IssueVol 11 No 5 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v11i5.1963
Keywords
Electrophoresis; Polyclonal gammopathy; Human immunodeficiency virus; Proteins; Analytes

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Nozarian Z, Mehrtash V, Abdollahi A, Aeinehsazi S, Khorsand A, Eftekhar-Javadi A, Safaei M, Nili F. Serum protein electrophoresis pattern in patients living with HIV: frequency of possible abnormalities in Iranian patients. Iran J Microbiol. 2019;11(5):440-447.