title: Monoclonal Gammopathy in HIV-1-Infected Patients: Factors Associated With Disappearance Under Long-Term Antiretroviral Therapy.
abstract: OBJECTIVE
  Monoclonal gammopathies (MGs) associated with HIV infection are frequent but their evolution and significance are uncertain in this population at high risk of lymphoproliferative disorder. Our aim was to describe the long-term evolution of MG in HIV-infected subjects under antiretroviral therapy.
  
  
  METHODS
  Retrospective study of HIV-1-infected adults, with a monoclonal (M) protein detected by serum protein electrophoresis and confirmed by immunofixation. Logistic regression was used to analyze factors associated with peak disappearance.
  
  
  RESULTS
  Between September 1997 and November 2012, 1219 serum protein electrophoreses were performed on our HIV cohort, and 137 (11.3%) MGs were detected. Seventy-seven subjects met the inclusion criteria: 68% male, median age 41 years, 47% AIDS stage, median CD4 count 237 per cubic millimeter, 81% uncontrolled HIV infection with HIV viral load over 400 copies per milliliter, 32% chronic hepatitis C, and 9% chronic hepatitis B. Eighteen subjects were not included because of previous or concomitant hemopathy. With a median follow-up of 6.8 years (interquartile range, 3.9-9.1), 66.2% of subjects showed a peak disappearance. In multivariate analysis, MG disappearance was associated with HIV virologic control (odds ratio, 5.98; 95% confidence interval: 1.63 to 21.87; P = 0.007) and the absence of hepatitis C virus replication at the end of follow-up (odds ratio, 10.16; 95% confidence interval: 2.36 to 43.69; P = 0.002). One subject developed a myeloma 3 years after the diagnosis of an IgA kappa MG.
  
  
  CONCLUSIONS
  MG associated with HIV infection concerned a young population and had favorable evolution on antiretroviral therapy in most cases. M protein disappearance was associated with HIV virologic control and the absence of chronic hepatitis C virus.
authors.affiliation: *Département de Maladies Infectieuses et Tropicales, CHRU Montpellier, Université de Montpellier, Montpellier, France; †UMI 233-INSERM U1175, Institut de Recherche pour le Développement, Université de Montpellier, Montpellier, France; ‡Département de Médecine Interne, Clinique Mutualiste Beau Soleil, Montpellier, France; §INSERM U1058, Université de Montpellier, Montpellier, France; ‖Département de Bactériologie-Virologie et Institut de Médecine Régénératrice et de Biothérapie, CHRU Montpellier, France; ¶Institut de Recherche en Sciences de la Santé IRSS, Ouagadougou, Burkina Faso; and #Département de Biochimie, CHRU Montpellier, Université de Montpellier, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Casanova
authors.forename: Alain
authors.initials: A
authors.lastname: Makinson
authors.forename: Sabrina
authors.initials: S
authors.lastname: Eymard-Duvernay
authors.forename: David-Eric
authors.initials: DE
authors.lastname: Ouedraogo
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Badiou
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Edouard
authors.initials: E
authors.lastname: Tuaillon
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007136:Immunoglobulins / Q000378:metabolism; D008297:Male; D010265:Paraproteinemias / Q000150:complications*; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents; D007136:Immunoglobulins