(Reuters Health) - (Reuters Health)—Monoclonal gammopathy occurs at a younger age and is more often associated with other viral infections in HIV-positive patients than in the general population, investigators in a multicenter report.
HIV-positive patients are more likely than the general population to develop monoclonal gammopathy of undetermined significance (MGUS), the authors explain, but its clinical features have not been studied extensively.
Dr. David M. Aboulafia from Virginia Mason Medical Center and University of Washington School of Medicine, Seattle, and colleagues described the clinical and immunologic features of MGUS in 25 HIV-infected patients and investigated whether effective highly active antiretroviral therapy (HAART) influences M-protein measurement.
The mean age of the patients at presentation was 44 years, the authors report, and the most common symptoms were fatigue, weight loss, and lymphadenopathy.
Serum M-protein levels ranged from 0.2 to 6.0 g/dL, the results indicate, and all but one patient had an IgG M-protein spike on protein electrophoresis, according to a report in the November 1st issue of Clinical Infectious Diseases.
Serum viscosity index was normal for most patients evaluated, the researchers note, and only 4 patients required plasmapheresis for hyperviscosity symptoms.
Just over half the patients tested showed a decrease in serum M-protein level after receiving HAART, the report indicates.
Seven patients were coinfected with hepatitis C virus, 2 had chronic active hepatitis B virus infection, and 1 had chronic active hepatitis B virus that cleared, the investigators say. All but 3 of 16 patients who underwent metastatic skeletal surveys had findings within normal limits.
Twenty-eight percent of the patients presented with or later received a diagnosis of malignancy. "This incidence of malignancy is higher than that for Virginia Mason Medical Center's general HIV-infected population (8%) and higher than that reported elsewhere," the researchers write.
"Although it remains unclear whether monitoring monoclonal gammopathies in asymptomatic HIV-infected patients allows early diagnosis of hematological malignancies, patient reassessment made a minimum of once per year seem to be prudent, given this population's higher incidence of plasma cell malignancies and non-Hodgkin's lymphoma," the authors conclude.
"The data are skewed by the fact that the authors included patients with known malignancy at presentation," writes Dr. Alexandra M. Levine from Keck School of Medicine, University of Southern California, Los Angeles, in a related editorial. "The more interesting question relates to the follow-up of these patients over time: will they, in fact, develop B cell malignancies at a rate higher than that expected in the usual population of HIV-infected individuals or higher than that described in the usual population of HIV-uninfected individuals with MGUS?"
"Additional work and more follow-up are clearly warranted to answer these important questions," Dr. Levine concludes.
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