Bone marrow - nonneoplastic
Infectious / inflammatory
HIV / AIDS

Author: Dragos Luca, M.D. (see Authors page)

Revised: 13 July 2017, last major update March 2015

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PubMed Search: HIV / AIDS bone marrow

Cite this page: HIV / AIDS. PathologyOutlines.com website. http://pathologyoutlines.com/topic/bonemarrowhiv.html. Accessed October 19th, 2017.
Definition / general
  • Must have high index of suspicion for opportunistic infections (acid fast bacilli, Parvovirus B19, Pneumocystis, Histoplasma) in HIV+ patients
  • Some recommend GMS and AFB stains on all marrow specimens in AIDS patients, AFB particularly where TB is endemic (Indian J Pathol Microbiol 2005;48:7)
  • HIV patients also have increased incidence of lymphoma / other malignancies, reduced iron stores (Am J Clin Pathol 2004;121:393)
  • Diagnostic yield for microorganisms is high for bone marrow biopsies (34%) and culture (27%), less (8%) for aspirate smears (J Infect 2007;54:362)
Clinical presentation and diagnosis
Case reports
Microscopic (histologic) description
  • Usually hypercellular (early in disease course) but interstitium may be loosely structured and hypocellular (Arch Anat Cytol Pathol 1991;39:137)
  • Hypocellularity in advanced disease and following potent therapy
  • Almost always increased plasma cells
  • Often scattered macrophages, dysplastic hematopoietic cells (J Assoc Physicians India 2005;53:705)
  • Marrow fibrosis, proportional to number of stained adventitial reticular cells (Arch Pathol Lab Med 2005;129:1137)
  • Variable acid fast bacilli without granulomas
  • Polymorphous reactive lymphoid hyperplasia
  • Proliferation of immunoblasts
  • Naked or pyknotic megakaryocyte nuclei (nonspecific, Mod Pathol 1994;7:166)
  • Focal fibrinoid necrosis or gelatinous transformation
  • Rarely macrophages with PAS+ or GMS+ Pneumocystis jiroveci
  • Iron storage abnormalities
Microscopic (histologic) images

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Hypercellular bone marrow

Stains
  • No light chain restriction in lymphocytes / plasma cells (unless malignant)
Differential diagnosis