BONE MARROW INVOLVEMENT IN HIV-INFECTED PATIENTS

• Main Authors: Cristina Olariu, Adriana Nurciu, Iulia Vasilescu, Ana Maria Alexandra Stănescu, Camelia Dobre, Liana Sticlaru, Mihai Olariu
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2018-06-01
• Series: Romanian Journal of Medical Practice
• Subjects: human immunodeficiency virus (hiv); acquired immunodeficiency syndrome (aids); cd4 + lymphocytes; lactic dehydrogenase (ldh); bone marrow; non-hodgkin lymphoma; opportunistic infections
• Online Access: https://revistemedicale.amaltea.ro/Romanian_Journal_of_MEDICAL_PRACTICE/Practica_medicala-2018-Nr.2/RJMP_2018_2_Art-15.pdf

Hematological involvement in HIV-AIDS patients consists of either immune deficiency or cytopenia on one, two or all the three cell lines. Available data estimate that 21-33% of HIV-infected patients develop bone marrow infiltration due to non-Hodgkin Malignant Lymphoma, one of the most commonly encountered hematological pathology in the clinical stage of AIDS. The risk of LMNH is strongly associated with the level of CD4+ lymphocytes. Our retrospective study included 25 HIV-infected patients, hospitalized between 2013 and 2017 in The National Center for Infectious Diseases I.N.B.I. "Prof. Dr. Matei Balş“. All of these patients underwent bone marrow biopsy for histopathological examination and supplementary immunohistochemistry tests in order to differentiate between lymphoma and other possible causes for bone marrow damage consistent with the clinical and biological pathological findings. Men gender accounted for 68% of the patients enrolled and the average age in our study was 33 years. Although 84% of the patients (21/25) had CD4+ lymphocyte levels < 200/μl associated with peripheral cytopenia, only 60% (15/25) also presented bone marrow abnormalities. Of these, the histopathological examination revealed HIV myelopathy in 7 cases while the other 8 patients presented in almost equal proportions bone marrow damage consistent with non-Hodgkin lymphoma or opportunistic infection (Mycobacterium avium intracellulare or Parvovirus B19). Following-up these patients one year after diagnosis we found out a fatal course in all the patients with bone marrow disease caused by HIV-associated non-Hodgkin lymphoma. HIV infected patients have various clinical and biological abnormalities and bone marrow damage is often met and often severe. Exploring the hematogenous marrow in these patients is of real use in identifying malignant hematological pathology and enable the correct differential diagnosis from opportunistic infection of bone marrow which may complicate the course of the disease.