UTILITY OF BONE-MARROW CULTURE AND BIOPSY IN THE DIAGNOSIS OF DISSEMINATED INFECTIONS IN AIDS

Bone marrow examination (BME) has been used as a diagnostic test of la st resort in HIV infected patients. Identifying factors that would inc rease the diagnostic yield of BME would be useful. A retrospective coh ort study was done to determine the predictive value of BME for dissem inated infection in 133 patients with HIV infection in a 4-year period at an active HIV clinical center. Thirty-two percent of the cases had evidence of a disseminated infection on BME but only 10% of cases had a diagnosis made exclusively by BME. Multivariate analysis demonstrat ed that a positive result was more likely in those patients with fewer than 50 CD4 cells/mm(3) and those with a hematocrit of less than 25% (P < 0.01). BME can be a useful, low-risk diagnostic procedure in sele cted patients with HIV infection who are ill with a low CD4 count and/ or have a hematocrit less than 25%. A diagnosis can usually be made by other means, suggesting that this test should be limited to those in whom other diagnostic modalities have been exhausted. (C) 1997 Wiley-L iss. Inc.