We would concede to Dr Keshgegian that our use of the term "surrogate diagnostic tool" may have been misleading and, perhaps, premature in the absence of supportive evidence. It was not our intention to imply that the presence of oligoclonal paraproteinemia should be used as a definitive test for identifying individuals with antibodies to HIV. However, we maintain our position that the presence of oligoclonal bands in the serum should alert the clinician to the possibility of HIV-related disease and that HIV-related disease should be considered in the differential diagnoses of patients demonstrating oligoclonal paraproteinemia. As a case in point, a clinician, not in our hospital, recently reported to us the following result of reading our letter: a patient with an undiagnosed illness and no association with any high-risk group, in whom oligoclonal paraproteinema had been demonstrated, was tested for antibodies to HIV and found to be seropositive.
Kouns DM, Marty AM, Sharpe RW. HIV-Related Oligoclonal Paraproteinemia-Reply. JAMA. 1987;257(7):928. doi:10.1001/jama.1987.03390070047015