Interactions between HIV infection and lymphoplasmacytoid lymphoma.

A case history of a man, who was found to have an asymptomatic lymphoplasmacytic lymphoma with an IgM paraproteinaemia and subsequently acquired HIV infection, is presented. After seroconversion there was a reduction in CD4+ cell count in the peripheral blood and bone marrow, together with an increase in CD 138+ cells in the marrow and disease progression with increasing paraprotein levels and falling haemoglobin. Following antiretroviral therapy (HAART) there was a reduction in viral titres, an increase in peripheral blood CD4+ cell counts together with a reduction in paraprotein and an improvement in haemoglobin. This case suggests that CD4+ cells play a role in controlling B cell proliferation and consequently that CD4 suppression contributes to the increased incidence of lymphoma in patients with HIV infection. We also discuss treatment options for this patient for should his LPL progress and require treatment in the future.