IgG abnormalities in HIV-positive Malawian women initiating antiretroviral therapy during pregnancy persist after 24 months of treatment

Abstract Objectives Hypergammaglobulinemia and anomalies in IgG subclasses distribution are common in HIV-infected individuals, and persist even after many years of ART. The aim of this study is to investigate on IgGs profile and dynamics in HIV-infected pregnant Malawian women in the Option B era. Methods 37 treatment-naive women received antiretroviral therapy (ART) from the third trimester of pregnancy to 6 months post delivery (end of breastfeeding period). ART continuation (group C) or interruption (group I) was then decided on the basis of the CD4+ cell count at enrollment (> or Results At enrollment 36/37 women had IgG levels over 15 g/l, with preponderance of IgG1 isotype (more than 90%) paralleled by underrepresentation of IgG2 (5.0%). After 6 months of ART both groups showed a significant median decrease of total IgG (group I:-3.1 g/l; group C:-3.5 g/l), and IgG1 (-4.0 and -3.6 g/l), but modest (group I: +0.16, group C: +0.14 g/l) recover in IgG2 levels. At month 24, hypergammaglobulinemia was still present in 73.7% of women of group C, although a significant reduction was observed in total IgG level, and IgG1 and IgG3 subclasses (p  Conclusions The beneficial effects of 24 months of ART appears to be limited in the B-cell compartment, with an incomplete reduction of total IgG levels and no recovery in IgG2 depletion. A short ART period did not have significant effects on IgG perturbation in women that interrupted treatment.