Myelodysplastic features in patients with long-term HIV infection and haemophilia

HIV-related bone marrow changes are consistent with myelodysplastic feature s (MDF). Their pathogenesis may differ from primary myelodysplastic syndrom es (MDS) and is associated with various factors including the virus itself or the antiretroviral therapy. In order to evaluate the differences between HIV-related MDF acid MDS, the morphological changes in peripheral blood an d bone marrow, cytogenetic analysis and the response to anaemia treatment w ere studied in 158 HIV+ patients with haemophilia and the results were comp ared with those of 61 patients with primary MDS (31 with RA, 10 with RARS, 11 with RAEB, three with RAEB-t and six with CMML). The eligibility criteri a for patients with MDS were primary MDS, Hb levels < 10 g dL(-1), and no s ignificant organ disease. The peripheral blood and bone marrow examination revealed MDF in 44 HIV-infected haemophilic patients (27.8%). The median ti me from seroconversion was 12.5 years and the mean time under AZT therapy w as 44.1 months. Nineteen of these patients (43.1%) had Hb levels < 10 g dL( -1), while neutropenia and thrombocytopenia were observed in 29.5% and 25%, respectively. Every patient of this study with Hb < 10 g dL(-1) received e rythropoietin (Epo). There were statistically significant morphological alt erations between HIV-related MDF and MDS: hypocellularity, plasmatocytosis and eosinophilia were more pronounced in HIV haemophiliacs with MDF, while dysplasia of erythroblasts, megakaryocytes and granulocytes was more freque nt in MDS patients. No HIV haemophilic patient with MDF had more than 5% bl asts in the bone marrow nor did any develop RAEB or acute leukaemia during the period of this study. The cytogenetic analysis was normal in HIV-infect ed patients with haemophilia whereas 42.6% of patients with MDS had an abno rmal karyotype. Complete erythroid response was achieved with Epo administr ation in 84.2% of HIV+ haemophilic patients with anaemia compared to 19.7% of patients with MDS. These data suggest that bone marrow changes in long-t erm HIV patients have different characteristics from primary MDS and consti tute the entity for which the name HIV-myelopathy has been proposed in the literature.