The Relevance Of CD4 Cell Counts and Abnormal Bone Marrow Findings Among HIV-Infected Patients

Hematologic and bone marrow abnormalities in patients with the HIV infection are common. The incidence of cytopenias correlates directly with the degree of immunosuppression. The causes of these abnormalities include impaired hematopoiesis, immune-mediated cytopenia, nutritional deficiencies, and drug effects.

The aim was to study the correlation of CD4 cell counts and bone marrow abnormalities in HIV-infected patients, including the clinical factors predicting bone marrow infection.

We retrospectively reviewed the records of HIV-infected adult patients who had undergone a bone marrow examination in Chiang Mai University Hospital between 2006 and 2010. The clinical characteristics, laboratory results and bone marrow findings were recorded.

There were 185 HIV-infected patients with a median age of 41 years (range 24-75). At the time of bone marrow examination, 84.3% of patients had fever and/or cytopenia in which 48% of them had bicytopenia/pancytopenia. Abnormal bone marrow findings were found in 77 (41.6%) patients, including dysplastic changes (22.1%), bone marrow infection (12.4%) and lymphoma involving bone marrow (2.7%). The bone marrow infection were independently associated with CD4 counts of less than 50/microlitre [OR 5.5 (95%CI: 1.21-25.46), p-value = 0.02], hepatosplenomegaly [OR 4.16 (95%CI: 1.40-12.34), p-value = 0.010] and fever > 38.5°C [OR 3.90 (95%CI: 1.06-14.28), p-value = 0.040]. Among patients with disseminated fungal infection, blood and bone marrow cultures were positive in 67.6% and 67.6%, respectively while only 37.8% of patients, fungi can be demonstrated microscopically in Wright-stained bone marrow smears. For patients with disseminated mycobacterial infection, blood and bone marrow cultures were positive in 44.4% and 77.8%, respectively while only one-third of patients, acid-fast bacilli can be detected microscopically in bone marrow smears.

Indices of suspected bone marrow infection among patients with HIV infection were lower CD4 cell counts of less than 50/microlitre, hepatosplenomegaly and high-grade fever. Blood and bone marrow cultures were more sensitive than microscopic examination of bone marrow in detection of disseminated fungal or mycobacterial infection. For feverish HIV patients, the specific antimicrobial therapy can be initiated promptly after microscopic detection of microorganism in the bone marrow smear.

No relevant conflicts of interest to declare.