377. Diagnostic Yield of Bone Marrow Aspiration and Biopsy in Human Immunodeficiency Virus Patients with Fever and/or Cytopenia

Abstract

BackgroundHuman Immunodeficiency Virus (HIV) patients are at increased risk of opportunistic infections and malignancies. Evaluation for the etiology of fever and/or cytopenia with conventional means such as cultures and serology can remain negative. Bone marrow aspiration or biopsy (BMAB) has the advantage of diagnosing disseminated infections, hematological abnormalities and oncological malignancies in HIV patients.MethodsWe performed a retrospective descriptive study of HIV patients with fever and/ or cytopenia who underwent Bone marrow aspiration or biopsy (BMAB). Patients with a diagnosis of HIV, 18 years and older who underwent BMAB in University Health (UH) Hospital or in UH clinics from January 2012 to February 2018 were included.ResultsThere were a total of 42 patients who underwent Bone Marrow Aspiration or Biopsy. The median age was 41.5 years. Twenty-eight patients were Male and 14 were female. Preexisting Hematological malignancy was present in 10 patients at the time of BMAB. Average CD4 count at the time of BMAB was 92. 8 patients were compliant with ART and 12 patients were compliant with clinic appointments. White Blood Cell (WBC) count below 4.4 cells / L was present in 30 patients at the time of BMAB. Disseminated Mycobacterium Avium Complex infection (2 patients),Disseminated Histoplasmosis (2 patients), Disseminated Cryptococcus (1 patient) and Parvovirus B19 (based on Immunohistochemistry, 1 patient) were diagnosed from BMAB. CD4 count of these 6 patients range from 0 to 12 at the time of BMAB. All 6 patients presented to the hospital with fever for evaluation. Average WBC count, Hemoglobin and platelet count in these patients are 4.1 cells / liter, 8.7 g/dL and 74.8 k/micro liter, respectively. All 6 patients were non compliant to HIV medications and clinic appointments.ConclusionSince the advent of Anti Retroviral drugs with excellent efficacy and early diagnosis of HIV patients, incidence of disseminated fungal and mycobacterial infections have decreased in the United States. But patients with low CD4 count and cytopenias warrant a Bone Marrow aspiration or Biopsy to make a clear and early diagnosis.Disclosures All authors: No reported disclosures.