title: Serum free light chains in patients with HIV infection: their association with markers of disease severity and antiretroviral use.
abstract: OBJECTIVE
  Serum free light chain measurements are used to follow-up and manage patients with monoclonal gammopathies, and abnormal ratios are associated with risk of progression in certain diseases. B cell dysfunction is well described in HIV and patients are at risk of developing B cell lymphomas. This study investigated whether HIV is associated with abnormal free light chain levels and the impact of antiretroviral treatment (ART) on these.
  
  
  METHODS
  κ And λ free light chain concentrations and ratios, serum albumin and immunoglobulin G (IgG) were measured in 366 HIV positive subjects and correlated with CD4+ counts, viral loads, IgG, albumin and ART use.
  
  
  RESULTS
  66% were women and most were black Africans (66%), 26% were of mixed ethnicity and 8% were Caucasian or of unknown or other race. 89% were on ART. κ Free light chain values ranged from 5.59 to 357.0 mg/L (median 19.6 mg/L) and λ free light chain values ranged from 9.28 to 286 mg/L (median 22.3 mg/L). Both correlated positively with viral load and IgG and negatively with CD4+ counts and albumin concentrations. The ratio only correlated with IgG concentrations. Patients on ART had significantly lower free light chain concentrations, but the ratio was not significantly affected.
  
  
  CONCLUSIONS
  This study demonstrated that free light chain concentrations were significantly correlated with markers of HIV disease severity, suggesting ongoing B cell dysfunction despite ART use. Free light chain ratio was not significantly affected.
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Annalise E
authors.initials: AE
authors.lastname: Zemlin
authors.affiliation: Division of Haematology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Hayley
authors.initials: H
authors.lastname: Ipp
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rensburg
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Jurie J
authors.initials: JJ
authors.lastname: Germishuys
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa Division of Haematology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa Division of Immunology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa Pathcare Private Laboratory, Bloemfontein, South Africa.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Esser
authors.affiliation: Division of Immunology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa Pathcare Private Laboratory, Bloemfontein, South Africa.
authors.forename: Madeleen
authors.initials: M
authors.lastname: Olivier
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa.
authors.forename: Rajiv T
authors.initials: RT
authors.lastname: Erasmus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000821:virology; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007145:Immunoglobulin kappa-Chains / Q000097:blood*; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D019380:Anti-HIV Agents; D015415:Biomarkers; D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D012709:Serum Albumin; D000075462:Serum Albumin, Human