Abstract 5594: Progression of paraproteinemia in HIV-positive versus HIV-negative patients
Authors: Jou Erin , Gligich Oleg , Chan Alvita CY , Mohan Diwakar , Felsen Uriel R. , Ayyappan Sabarish , Billett Henny H. , Hui Edwin P. , Chan Anthony TC , Raghupathy Radha 
Published: August 2015

BACKGROUND: Paraproteinemias occur in 1 to 3% of people over the age of 50 and progress to hematological malignancies (HM) at the rate of about 1% per year. In HIV+ patients a higher incidence of paraproteinemia has been reported however the rate of progression to HM remains unclear. We studied a large database comparing HIV+ and HIV- patients with paraproteinemia for incidence of HM.

METHODS: Patients tested for HIV who also had a serum protein electrophoresis test (SPEP) performed between January 1st 2001 and December 31st 2011 were identified using a medical database at a large tertiary care center. SPEP+ patients were stratified into distinct (D-SPEP) or faint/multiple/oligoclonal (F-SPEP) bands by an independent laboratory technician. Demographics, coinfections and biopsy data were reviewed.

RESULTS: 181,851 patients underwent a HIV test and 10,293 were HIV+. Significantly greater number of HIV+ patients (1381 of 10,293) compared to HIV- (6512 of 171,588) were tested for paraprotein (13.4% vs 3.8%, p&lt;0.0001). Of those tested, the prevalence of SPEP positivity was higher in HIV+ (266 of 1381) versus HIV- (537 of 6512) (19.3% vs 8.2%, p&lt;0.0001). HIV+ SPEP+ patients were more likely to have F-SPEP and light chain paraproteins compared to their HIV- counterparts. HIV+SPEP+ patients were significantly more likely to be tested and more likely to be positive for hepatitis B and C co infections.

HIV- SPEP+ patients were more likely to have a D-SPEP and IgA and IgM subtype paraproteins than HIV+ patients. HIV- patients also had a higher incidence of HM which persisted when adjusted for year of SPEP and duration of follow up (p&lt;0.0001).

CONCLUSIONS: While a higher prevalence of paraproteinemia was noted in the HIV+, HM incidence was lower in the HIV+ compared to HIV-, suggesting that nonmalignant virus-dependent proliferation may lead to paraproteinemia in some HIV+ cases. Identification of HIV+SPEP+ cases with higher risk of HM will be clinically relevant.

Table 1.Comparison of HIV+SPEP+ and HIV- SPEP+ patientsCharacteristicHIV+ SPEP+ (n = 266)HIV- SPEP+ (n = 537)p value(Chi square/ Fishers exact/ t-test)Age at SPEP test (yrs)50 (SE: 0.54)59 (SE: 0.55)&lt;0.0001*F-SPEP (n,%)234 (88%)342 (63.7%)&lt;0.0001D-SPEP (n,%)32 (12%)195 (36.3%)&lt;0.0001*IgG (n,%)209 (78.6%)372 (73.5%)0.136IgM (n,%)4 (1.5%)42 (8.3%)&lt;0.0001*IgA (n,%)3 (1.1%)40 (7.9%)&lt;0.0001*Light chain (n,%)24 (9%)23 (4.5%)0.013Hepatitis C positive by serology/ viral load of those tested113/246 (45.9%)78/412 (18.9%)&lt;0.0001HBsAg/ Hepatitis B viral load positive of those tested22/241 (9.1%)4/254 (2.6%)0.012Follow up after SPEP test (months)23360.003HM (n,%)17 (6.5%)83 (16.1%)&lt;0.0002HM+ of F-SPEP+12/234 (5.1%)34/342 (9.9%)0.042HM+ of D-SPEP+5/32 (15.6%)49/195 (25%)0.369

Citation Format: Erin Jou, Oleg Gligich, Alvita CY Chan, Diwakar Mohan, Uriel R. Felsen, Sabarish Ayyappan, Henny H. Billett, Edwin P. Hui, Anthony TC Chan, Radha Raghupathy. Progression of paraproteinemia in HIV-positive versus HIV-negative patients. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5594. doi:10.1158/1538-7445.AM2015-5594