Effect of combination antiretroviral treatment on total protein and calculated globulin levels among HIV-infected patients.
OBJECTIVE
Hypergammaglobulinemia is one of the manifestations of B-cell dysfunction associated with untreated HIV infection. Globulin levels are not routinely measured in HIV-infected patients on treatment. The purpose of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) on calculated globulin levels.


METHODS
The study group consisted of 75 HIV-infected treatment-naïve patients, starting HAART, and virologically suppressed for ≥6 months; 16 patients (21%) were HIV-HCV-co-infected.


RESULTS
All patients experienced significant increases in CD4 cell counts at 6 and 12 months after HAART initiation compared to baseline (p<0.01 for all comparisons). The increase in CD4 cell counts was significant regardless of the HCV infection status. Significant increases in albumin levels (p<0.05 at 6 and 12 months), reductions in total protein (p<0.01 at 1 year; not significant at 6 months), and concomitant significant reductions in the calculated globulin levels (p<0.001 at 6 and 12 months) after HAART initiation compared to baseline were observed for the whole group. However, less than half the patients achieved a normal albumin/globulin ratio at 1 year. HIV-monoinfected patients had significant changes in albumin, total protein, and calculated globulin levels. In contrast, HIV-HCV-co-infected patients only showed significant increases in albumin levels.


CONCLUSIONS
Future studies to evaluate the potential use of calculated globulin levels and albumin/globulin ratios as readily available surrogate markers of B-cell immune reconstitution in HIV-monoinfected patients are warranted.
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Jose
J
Serpa
Danish
D
Haque
Josemon
J
Valayam
Katharine
K
Breaux
Maria C
MC
Rodriguez-Barradas
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D001798:Blood Proteins / Q000187:drug effects* / Q000378:metabolism*; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000276:immunology; D006801:Humans; D006942:Hypergammaglobulinemia / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012712:Serum Globulins / Q000187:drug effects* / Q000378:metabolism*; D013997:Time Factors
D001798:Blood Proteins; D012712:Serum Globulins