[Paraproteins and lymphoma in HIV positive patients].

BACKGROUND AND AIM: Compared to healthy subjects there is a higher incidence of monoclonal immunoglobulins (= paraproteins = PP) in patients infected with the human immunodeficiency virus (HIV). High-grade B-cell non-Hodgkin's lymphomas (NHL) are the second most common neoplasms in these patients. Our aim was to determine whether paraproteins would be of diagnostic significance regarding an underlying or developing NHL.

PATIENTS AND

METHODS

The sera of 202 HIV-positive patients were tested for the presence of monoclonal or oligoclonal bands by using high-resolution-electrophoresis (HRE) and immunofixation (IFX). We also examined immunoglobulin concentrations, leucocyte count, lymphocyte count, CD4 lymphocyte count and CD4/CD8-ratio and collected clinical data.

RESULTS

Paraproteins were detected in 26 (12.8%) of the patients. 84.6% of PP were IgG, in 80.7% associated with a kappa light chain. Patients with monoclonal or oligoclonal bands developed NHL significantly more often compared to those without PP (16.7% and 2.8%, respectively (p < 0.05%)). The CD4 count was significantly higher in patients with PP. There was no difference in levels of immunoglobulins, leucocyte count, lymphocyte count and CD4/CD8-ratio. The prevalence of PP was equally distributed in patients at different CDC-stages of HIV-infection. Common acute systemic infections like pneumocystis carinii pneumonia (PCP), toxoplasmosis, mycobacteriosis or cytomegalovirus (CMV) infection were not associated with paraproteins.

CONCLUSION

We conclude that paraproteins could indicate the presence of a non-Hodgkin's-lymphoma.