DIAGNOSTIC UTILITY OF BONE-MARROW SAMPLING IN HIV-POSITIVE PATIENTS

Objective: To evaluate the diagnostic utility of bone marrow (BM) samp ling in HIV positive patients. Design: Retrospective cohort analysis. Setting: Specialist HIV/AIDS service in London. Subjects: 215 consecut ive HIV infected patients undergoing 246 BM samplings for investigatio n of pyrexia without localising signs, haematological abnormalities, o r staging/investigation of lymphoma. Main outcome measure: Diagnostic yield from (and impact on management of) BM sampling. Results: Of 122 BM samples taken to investigate pyrexia, 33 (27%) revealed the cause o n microscopy: unexpected lymphoma in seven (6%), mycobacteriosis in 25 (20%), and toxoplasmosis in one (1%). Marrow infiltration was confirm ed in 11 of 38 BM samples taken for staging/investigation of lymphoma/ leukaemia. In afebrile patients, of 22 with pancytopenia, BM samples s howed HN associated changes in 17 and specific diagnoses in five (myco bacterial infection in three, haemophagocytic syndrome in one, and meg aloblastic change due to vitamin B-12 deficiency in one); of 21 with i solated thrombocytopenia, 20 (95%) BM samples showed immune thrombocyt openic purpura to be the cause and the remaining patient had BM change s of aplasia; of 29 with isolated anaemia, 28 had BM changes of HIV as sociated dysplasia/erythroid dysplasia and one had unsuspected iron de ficiency; all 10 with isolated leucopenia/neutropenia had BM changes a scribed to HIV infection exacerbated by concurrent sepsis or medicatio n; of four BM samples taken for other reasons, one showed mycobacteria l infection. Conclusions: BM sampling has diagnostic utility in HIV in fected patients with pyrexia without localising signs, pancytopenia, a nd staging/investigation of lymphoma; this test has little value in th e investigation of afebrile patients with isolated thrombocytopenia, a naemia, or leucopenia as HIV is usually the underlying cause.