title: Diagnostic utility of bone marrow sampling in HIV-infected patients since the advent of highly active antiretroviral therapy.
abstract: We investigated the diagnostic value of bone marrow (BM) sampling in investigation of HIV-infected patients presenting to a major London HIV treatment centre between 1999 and 2004. One hundred and fourteen consecutive patients underwent 130 BM samplings. The majority of BM aspirates were normal or showed non-diagnostic changes; microscopy revealed lymphoma in one and mycobacterial infection in two. Subsequent culture identified mycobacterial infection in nine samples. BM trephine had a diagnostic yield of 26% in patients with fever and cytopaenia (including mycobacteriosis in 14%, lymphoma in 6%, Castleman disease in 3% and "drug effect" in 3%), a yield of 20% in patients with fever, but no cytopaenia (mycobacteriosis in each case), and a yield of 19% in patients with cytopaenia in the absence of fever (lymphoma in 5% and "drug effect" in 14%). In investigation/staging of lymphoma, the diagnostic yield was 36%. The overall yield from BM sampling was 30% in patients receiving highly active antiretroviral therapy (HAART) and 23% in those not receiving HAART. In this study, BM sampling was of most diagnostic value in HIV-infected patients where fever and cytopaenia coexisted in the absence of localizing signs of infection, and in the staging/investigation of lymphoma. BM sampling had less diagnostic value in the investigation of fever without cytopaenia or cytopaenia without fever.
authors.affiliation: Patrick Manson Unit, University College London Hospitals (NHS) Trust, London WC1E 6AU, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Llewelyn
authors.forename: M
authors.initials: M
authors.lastname: Noursedeghi
authors.forename: A
authors.initials: A
authors.lastname: Dogan
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000740:Anemia / Q000175:diagnosis; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001853:Bone Marrow / Q000382:microbiology* / Q000473:pathology; D001856:Bone Marrow Examination / Q000592:standards*; D005260:Female; D005334:Fever / Q000209:etiology; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D007970:Leukopenia / Q000175:diagnosis; D008297:Male; D009164:Mycobacterium Infections / Q000175:diagnosis
chemical_list: D019380:Anti-HIV Agents