HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS

Hemalatha Kuppan,Vanishri Ashok,Urmila Niranjan Khadilkar,Sridevi Hanaganahalli Basavaiah,Nirupama Murali

doi:10.51248/.v41i4.904

Abstract

Introduction and Aim: Haematological manifestations in HIV disease is common and can happen at any phase during the disease course. Anemia and thrombocytopenia are the most frequent hematologic abnormalities and are associated with high morbidity and mortality. The objective of current study was to observe and analyse various spectrum of bone marrow changes and haematological abnormalities in HIV/AIDS and to correlate findings with CD4 count. Material and Methods: A total of 44 patients over a period of 5 years were included. Clinical findings, hematological profile, bone-marrow aspirate, biopsy findings and CD4 count of these patients were documented. The association between absolute lymphocyte count (ALC) and CD4 count were further established. Results: The most common clinical indication for bone-marrow aspiration and trephine biopsy was pancytopenia (47.3%), pyrexia of unknown origin (15.1%), and unresolving hepatosplenomegaly (13.6%). Anemia (72.7%) was commonest haematological abnormality. Bone marrow aspirate was normocellular in majority of patients. Marrow findings were correlated with CD4 count and were found to be statistically significant. Tri-lineage dysplasia was observed in 9.1% of patients, and megakaryocytic dysplasia being the commonest(61.4%). Histiocytic aggregates (27.3%) were noted among which 6.8% showed acid fast bacilli in Ziehl-Neelsen stain. Fungal stains revealed histoplasmosis in 4.5% patients. Conclusion: There was a strong negative association between presence of anemia and dysplasia and CD4 count. When CD4 was <200/µL and ALC<1000/mm3, presence of anemia and dysplasia affecting various cell lines were commonly observed; therefore, can be used as indicators to assess the severity of the disease.

Highlights

Introduction and AimHaematological manifestations in Human immunodeficiency virus (HIV) disease is common and can happen at any phase during the disease course
Bone marrow examination was performed as a part of workup for pyrexia of unknown origin (PUO), unresolving hepatosplenomegaly or as a part of evaluation of refractory anemia, leucopenia, neutropenia, lymphopenia or thrombocytopenia
bone marrow (BM) abnormalities are more consistently seen in HIV patients with advanced disease who are on antiretroviral therapy (ART) or associated with neoplasms and opportunistic infections; they can occur in patients without ART, infections or malignancy

Summary

Introduction

Introduction and AimHaematological manifestations in HIV disease is common and can happen at any phase during the disease course. The objective of current study was to observe and analyse various spectrum of bone marrow changes and haematological abnormalities in HIV/AIDS and to correlate findings with CD4 count. The first case of acquired immunodeficiency syndrome (AIDS) was identified in United States in 1981, and in 1983, HIV was isolated from a case of lymphadenopathy [2]. In the year 2019, there were 38 million people living with HIV (PLHIV) globally with 1.7 million new cases and 6,90,000 AIDS-related deaths documented by the end of the year [3]. India reported 23.48 lakh cases of PLHIV in 2019 and there were 69.22 thousand new cases with adult HIV prevalence of 0.22% between 15-49 years. National AIDS-related deaths documented in 2019 was 58.96 thousand [4]

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