PARAPROTEINEMIA, PLASMACYTOMA, MYELOMA AND HIV-INFECTION

We have identified by MEDLINE search the cases of gammaglo-binopathy a nd plasma cell malignancy in HIV-positive patients reported in the Eng lish language literature, The average age at presentation among HIV-po sitive patients with plasma cell disorders is 33 years, far younger th an the average age of presentation in the general population. Some of these patients present with transient paraproteinemias, while others h ave persistent paraproteins, which may or may not be associated with t rue plasma cell malignancies. In most cases in which it has been exami ned, the paraprotein contains high-titer anti-HIV activity. The presen ce of high titer anti HIV activity in the paraproteins of AIDS patient s suggests that an antigen-driven process in response to HIV infection may contribute to the early development of plasma cell disorders in t hese patients. Recent work In plasma cell tumorigenesis has indicated that transformation at a single point in the B lymphocyte lineage can give rise to either lymphoma or myeloma, dependent upon environmental factors such as T cell function, which may be required for directing t ransformed lymphocytes from lymphoma and towards plasma cell different iation. This may explain why B lineage oncogenesis in AIDS patients fa vors the development of lymphoma over that of myeloma.