Bone marrow nonneoplastic
Infectious / inflammatory
HIV / AIDS
Author: Dragos C. Luca, M.D.
Last author update: 1 March 2015
Last staff update: 1 September 2021
Copyright: 2002-2019, PathologyOutlines.com, Inc.
PubMed Search: HIV / AIDS bone marrow
Table of Contents
Definition / general | Clinical presentation and diagnosis | Case reports | Microscopic (histologic) description | Stains | Differential diagnosis | Additional referencesCite this page: Luca DC. HIV / AIDS. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bonemarrowhiv.html. Accessed November 28th, 2024.
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
- Acute HIV syndrome (initial infection): sore throat, fever, lymphadenopathy (50 - 70% of patients)
- Opportunistic infections are due to progressive decrease in CD4+ T cells, often below 200/microliter
- Malignancies (secondary and virus associated) may be EBV associated: Burkitt lymphoma, Hodgkin lymphoma, plasmablastic lymphoma or HHV8 associated: Kaposi sarcoma, primary effusion lymphoma
- Neurodegenerative disease: PML / progressive multifocal leukoencephalopathy
- Other: multicentric Castleman disease (HHV8 associated), atherosclerosis
- Hematologic findings: anemia, neutropenia, lymphopenia, thrombocytopenia
Case reports
- 44 year old AIDS patient presenting with cutaneous Kaposi sarcoma and bacillary angiomatosis (AIDS Patient Care STDS 2002;16:573)
- HIV+ man who died after bleeding from mouth and nose (University of Pittsburgh: HIV Positive Man Died Following Bleeding from Mouth and Nose)
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
Stains
- No light chain restriction in lymphocytes / plasma cells (unless malignant)
Differential diagnosis
- Hodgkin lymphoma
- Peripheral T cell lymphoma: rare, T cell receptor rearrangements
