Q J Med 2001; 94: 101-105
© 2001 Association of Physicians
The utility of bone-marrow examination in HIV-infected adults in South Africa
1 From the Department of Medicine, Chris Hani Baragwanath Hospital 2 Department of Anatomical Pathology, South African Institute for Medical Research, and University of the Witwatersrand, Johannesburg, South Africa
Received 16 February 2000 and in revised form 27 November 2000
We retrospectively reviewed a consecutive case series of 257 adults with HIV infection who had undergone a bone-marrow examination with trephine bone biopsy, to assess the diagnostic usefulness of bone-marrow examination and evaluate possible predictors of a diagnostic examination. Bone-marrow examination was positive in 97 (38%) patients and gave a unique diagnosis in 61 (24%). The diseases were tuberculosis (83 patients), Mycobacterium avium complex infection and cryptococcosis (four patients each), and haematological malignancies (eight patients). The yield of the examination was significantly increased, by univariate analysis, in patients with wasting, oral thrush, leukopenia, CD4
100/mm3, and granuloma formation on histopathology. Granulomata were present in 113 (44%) patients, of whom 28 (25%) had no specific cause identified. Granulomata occurred in 22 (25%) of 89 patients with CD4 >100/mm3 compared to 36 (51%) of 70 patients with CD4100/mm3 (OR 0.3; 95%CI 0.15–0.62). Of 48 patients with CD4 <50/mm3, 25 had granulomata, including 15 with caseation necrosis. The yield of bone-marrow examination was considerable in our setting. Expanding access to modern blood culture techniques for mycobacteria to primary care level could limit the number of bone-marrow examinations required.
Address correspondence to Dr A.S. Karstaedt, Department of Medicine, Chris Hani Baragwanath Hospital, P.O. Bertsham, 2013, Johannesburg, South Africa. e-mail: 014alan{at}chiron.wits.ac.za