IgG abnormalities in HIV-positive Malawian women initiating antiretroviral therapy during pregnancy persist after 24 months of treatment. (November 2019)

• Record Type: Journal Article
• Authors: Baroncelli, Silvia; Maria Galluzzo, Clementina; Liotta, Giuseppe; Orlando, Stefano; Ciccacci, Fausto; Andreotti, Mauro; Mpwhere, Robert; Luhanga, Richard; Sagno, Jean Baptiste; Amici, Roberta; Marazzi, Maria Cristina; Giuliano, Marina
• Is Part Of: International journal of infectious diseases. Volume 88(2019)
• Page Start: 1
• Page End: 7
• Publication Date: 2019-11
• Subjects: HIV -- Africa -- Pregnancy -- Hypergammaglobulinemia -- IgG subclasses; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2019.09.001
• Languages: English
• ISSNs: 1201-9712

Abstract

Graphical abstract: Highlights: Hypergammaglobulinemia is common in Malawian HIV-positive pregnant women. Twenty-four months of antiretroviral therapy improved but did not normalize IgG anomalies. The IgG2 isotype remained highly underrepresented. The potential influence of immunoglobulin disorders should be considered when assessing the risk of infection in HIV-exposed infants. Abstract: Objectives: Hypergammaglobulinemia and anomalies in the IgG subclass distribution are common in HIV-infected individuals and persist even after many years of antiretroviral therapy (ART). The aim of this study was to investigate the IgG profile and dynamics in pregnant HIV-infected Malawian women in the Option B era. Methods: Thirty-seven treatment-naive women received ART from the third trimester of pregnancy to 6 months post delivery (end of the breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrolment (>350 or ≤350/μl). Total IgG and IgG subclasses were determined in maternal serum using a nephelometric assay at baseline and at 6 and 24 months postpartum. Results: At enrolment, 36/37 women had IgG levels >15 g/l and there was a predominance of the IgG1 isotype (more than 90%) in parallel with underrepresentation of IgG2 (5.0%). After 6 months of ART, both groups showed a significant median decrease in total IgG (−3.1 g/l in group I, −3.5 g/l in group C) and in IgG1 (−4.0 g/l and −3.6 g/l, respectively), but only a modest recovery in IgG2 levels (+0.16 in group I, +0.14 g/l in group C). At month 24, hypergammaglobulinemia was still present in 73.7% of women in group C, although a significant reduction was observed in total IgG level and in IgG1 and IgG3 subclasses ( p < 0.0001 in all cases). IgG2 levels did not show any significant change. In group I at 24 months, total IgG and IgG subclasses had returned to levels comparable to those at baseline. Conclusions: The beneficial effects of 24 months of ART appear to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery of IgG2 depletion. A short ART period did not have significant effects on IgG abnormalities in women who interrupted treatment.