The utility of bone-marrow examination in HIV-infected adults in South Africa

We retrospectively reviewed a consecutive case series of 257 adults with HI V infection who had undergone a bone-marrow examination with trephine bone biopsy, to assess the diagnostic usefulness of bone-marrow examination and evaluate possible predictors of a diagnostic examination. Bone-marrow exami nation was positive in 97 (38%) patients and gave a unique diagnosis in 61 (24%). The diseases were tuberculosis (83 patients), Mycobacterium avium co mplex infection and cryptococcosis (four patients each), and haematological malignancies (eight patients). The yield of the examination was significan tly increased, by univariate analysis, in patients with wasting, oral thrus h, leukopenia, CD4 less than or equal to 100/mm(3), and granuloma formation on histopathology. Granulomata were present in 113 (44%) patients, of whom 28 (25%) had no specific cause identified. Granulomata occurred in 22 (25% ) of 89 patients with CD4 >100/mm(3) compared to 36 (51%) of 70 patients wi th CD4 less than or equal to 100/mm(3) (OR 0.3; 95% Cl 0.15-0.62). Of 48 pa tients with CD4 < 50/mm(3), 25 had granulomata, including 15 with caseation necrosis. The yield of bone-marrow examination was considerable in our set ting. Expanding access to modern blood culture techniques for mycobacteria to primary care level could limit the number of bone-marrow examinations re quired.