The recent article by Karnad et al. [ 11 in the Journal, described a young HIV-infected patient with a disseminated plasma cell tumor (PCT). This report helps to lend strength to the argument that PCT in HIV-infected patients should support the diagnosis of the acquired immune deficiency syndrome (AIDS). A recent report by Gold et al., described two HIV-infected patients with PCT that share a number of common features with the patient described by Karnad et al. [I]. One patient was similar to the case described by Karnad et al. [ I ] because the PCT was disseminated in such sites as skin and lymph nodes. Because of the lymphoma-like behavior of the disseminated PCT (as recently described by Barlogie et al. [3]), the patient was treated with the MACOP-B protocol for aggressive non-Hodgkin lymphoma and is currently disease free at 24 months. In addition, both patients described by Gold et al. [2] were similar to the case of Karnad et al. because they had polyclonal hypergammaglobulinemia and lacked a measurable M-protein. Further, as pointed out by Karnad et al., HIV-infected patients with PCT tend to be younger than 40 years of age, which is quite rare in non-HIV-infected patients with PCT. Both HIV-infected patients with PCT described by Gold et al. [2] were also younger than age 40 years.
It has been shown that plasmacytoma-bearing mice infected with the 5-3 murine retrovirus have markedlv PCT in the setting of HIV-induced immune deficiency. Because of the young age at onset and the disseminated aggressive nature of these HIV-associated PCT, it would appear warranted to include HIV-infected patients with PCT in the definition of AIDS.