REVISITED INDICATIONS FOR BONE-MARROW EXAMINATIONS IN HIV-INFECTED PATIENTS

We reviewed the indications for sind the results of bone marrow examin ation (BME) from HIV-infected patients as an attempt to improve its di agnostic yield. One-hundred-and-eight bone marrow specimens from 90 pa tients during a 3-year period were examined. A cytological, histologic al and microbiological study was carried out on the specimens. Forty-t hree evaluable examinations (40% of total) performed for cytopenia sho wed normo- or hypercellularity in 33 (77%). Fifty bone marrow specimen s were cultured for mycobacteria with a yield of 42% when the indicati on was persistent fever. Positive cultures yielded Mycobacterium avium complex in 8 out of 12 patients. Twenty-seven patients had both cultu re and biopsy; granulomas were associated with all the positive (10/10 ) and with 1 out of 17 negative cultures (chi-square test: p < 0.001). A bone marrow involvement with lymphoma was found in 2 out of 6 patie nts with previously diagnosed lymphoma, and biopsy revealed a lymphoma in 2 patients. Morphological bone marrow examination should be associ ated with other techniques in order to appreciate bone marrow producti on. Bone marrow biopsy is useful for the investigation of persistent f ever since granulomas suggestive of disseminated mycobacteria are freq uent and allow a treatment to be initiated before microbiological conf irmation and antibiotic susceptibility test.