Cutaneous T-Cell Lymphoma and Human Immunodeficiency Virus:  The Spectrum Broadens

As the epidemic of acquired immunodeficiency syndrome (AIDS) continues, it has become well recognized that individuals infected with the human immunodeficiency virus (HIV) are at increased risk for the development of various cancers. In this issue of the Archives, Crane et al¹ and Nahass and coworkers² describe five patients with documented HIV infection, who developed skin diseases that were believed to represent cutaneous T-cell lymphoma (CTCL). These findings, at first, seem to challenge our conventional views on both diseases. How can CTCL—most commonly seen as a proliferation of CD4⁺ helper T lymphocytes— develop in an individual with AIDS, in whom these same helper T cells are progressively destroyed by HIV? To accept the coexistence of HIV infection and CTCL as other than a mere coincidence, one must reexamine the pathogenesis of malignancies in HIV infection, as well as the diverse nature of malignant T cells in the skin.