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31 EFFECT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ON BRONCHOALVEOLAR LAVAGE IMMUNOGLOBULIN G SUBCLASS LEVELS IN HIV-POSITIVE PATIENTS.
  1. S. Lodhi,
  2. R. B. Day,
  3. P. A. Smith,
  4. C. Huffer,
  5. H. L. Twigg III
  1. Indiana University Medical Center, Indianapolis, IN

Abstract

Background and Objective HIV infection in the lung is characterized by lumphocytic alveolitis and a state of chronic alveolar macrophage and lung lymphocyte activation resulting in enhanced cytokine secretion and hypergammaglobulinemia. It has been shown that HAART is associated with a generalized decline in cytokine secretion, especially interferon-gamma (IFN-g), and reduced IgG and IgM production. We examined the effect of HAART on IgG subclasses, including the IFN-g-dependent subclass IgG2.

Methods IgG subclass levels were measured in BAL of 20 HIV-infected patients before and at 24 weeks after initiation of HAART using a human IgG subclass ELISA kit. Cytokine concentrations were measured using a cytokine bead array assay. IgG and cytokine concentrations were corrected for BAL dilution by determining epithelial lining fluid (ELF) using the urea dilution technique.

Results Data expressed as mean ± SEM μg IgG/mL ELF (*p value ≥ .05).

HAART was associated with a significant decline in IgG2 and IgG3 levels. Unlike normal subjects, BAL IgG2 levels were higher than IgG1 levels, a difference persisting even after 24 weeks of HAART. A significant correlation was found between IFN gamma levels and IgG1 (R = .47, p = .03), IgG2 (R = .53, p = .02) and IgG3 (R = .53, p = .02) before initiation of HAART. This did not persist at week 24. IL-6 levels and IgG1 levels were found to be positively correlated at the time of entry (R = .46, p = .04). None of the other subclasses demonstrated any significant correlation with IL-6 levels.

Conclusion HIV infection is associated with increased IgG2 in the lungs of HIV infected patients, possibly due to elevated IFN-g concentrations in the lung. While this is partially correcting after 6 months of HAART, IgG2 levels still remain elevated in the lung, probably due to the long half-life of IgG.

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