BONE-MARROW ASPIRATES AND BIOPSIES IN CHILDREN WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Purpose: Hematopoietic abnormalities are common in patients infected w ith the human immunodeficiency virus (HIV). We evaluated the role of d iagnostic bone marrow aspirations and biopsies in HIV-infected childre n. Methods: Seventy-eight bone marrow biopsies and aspirates performed during the last 8 years at the Pediatric Branch of the National Cance r Institute from 60 children with symptomatic HIV infection were revie wed retrospectively. The results were correlated with clinical stage, use of antiretroviral therapy or hematopoietic growth factors, and hem atopoietic parameters. Results: Most patients (84%) showed a normal or hypercellular marrow, associated with diffuse lymphocytosis (50%) or therapy with hematopoietic growth factors (33%). Dyspoietic features w ere very common in all three cell lineages. Twenty-seven (44%) of the patients had decreased iron stores in the bone marrow that correlated with iron deficiency as documented by serum tests in more than one-thi rd of our study population. Bone marrow cultures were not more helpful than peripheral cultures in establishing the diagnosis of an opportun istic infection. Conclusion: Although bone marrow abnormalities are ve ry common in HIV-infected children, they are rarely specific. The role of diagnostic bone marrow aspirates and biopsies appears to be limite d, and this invasive procedure should be reserved for specific situati ons (e.g., to rule out a malignancy>.