Hematologic Manifestations of HIV/AIDS

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Chapter 71 Hematologic Manifestations of HIV/AIDS

Peripheral Blood Smear and Bone Marrow Morphology in HIV/AIDS

The peripheral blood smear of a patient with HIV/AIDS might show anisocytosis, poikilocytosis, and rouleaux formation. Anemia when present is usually normocytic and normochromic. Sometimes macrocytic anemia can be seen even in the absence of zidovudine therapy. Lymphopenia is seen in advanced disease. Hypogranular neutrophils and Pelger-Huët forms are rarely present. Platelets can be normal or hypogranular. In cases of thrombocytopenia the platelets can be normal-sized or large when thrombocytopenia is due to immune destruction with preserved marrow function.

The bone marrow is usually hypercellular but can be normocellular or hypocellular. Interstitial and perivascular polyclonal plasmacytosis is usually present. HIV-associated stromal changes include edema, gelatinous transformation, and increased reticulin fibers (dense collagen fibers are not a feature of HIV). Normal bone marrow architecture is often disturbed, and dysplastic changes can be seen, including dyserythropoiesis, dysgranulopoiesis, and abnormal megakaryocytes (including clusters and bare megakaryocytic nuclei). However, the following features distinguish the bone marrow morphology in HIV from that of myelodysplastic syndrome (MDS): Dysplasia is less severe in HIV. Dyserythropoiesis occurs mainly in patients on highly active antiretroviral therapy (HAART). Megaloblastic changes are associated with zidovudine therapy. Whereas erythropoiesis is usually hyperplastic in MDS, myeloid/erythroid ratio is usually normal in HIV. Increased blasts can be seen in MDS but never in HIV. Lastly, in contrast to MDS, the basement membrane in HIV often shows eosinophilia, lymphohistiocytic infiltrates, and plasmacytosis.

AIDS, Acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

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Figure 71-3 BURKITT LYMPHOMA INVOLVING THE BONE MARROW OF A PATIENT WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS).

(Zhao X, Sun NC, Witt MD, et al: Changing pattern of AIDS: A bone marrow study. Am J Clin Pathol 121:393, 2004.)

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Figure 71-4 CLASSIC HODGKIN LYMPHOMA INVOLVING THE BONE MARROW OF A PATIENT WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS).

(Zhao X, Sun NC, Witt MD, et al: Changing pattern of AIDS: A bone marrow study. Am J Clin Pathol 121:393, 2004.)

Table 71-1 Surveillance Case Definition for HIV Infection in Adults and Adolescents (Age Over 13 Years)

Stage Laboratory Evidence Clinical Evidence
Stage1 Laboratory confirmation of HIV infection and CD4+ T-lymphocyte count of ≥500 cells/µL or CD4+ T-lymphocyte percentage of ≥29* No AIDS-defining condition (see Table 71-2)
Stage 2 Laboratory confirmation of HIV infection and CD4+ T-lymphocyte count of 200-499 cells/µL or CD4+ T-lymphocyte percentage of 14-28* No AIDS-defining condition (see Table 71-2)
Stage 3 Laboratory confirmation of HIV infection and CD4+ T-lymphocyte count of <200 cells/µL or CD4+ T-lymphocyte percentage of <14* Documentation of an AIDS-defining condition with laboratory confirmation of HIV infection (see Table 71-2)
Stage unknown Laboratory confirmation of HIV infection and no information on CD4+ T-lymphocyte count or percentage No information on presence of an AIDS-defining condition

AIDS, Acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

*The CD4+ T-lymphocyte percentage is the percentage of the total lymphocyte count.

Table 71-2 Surveillance Definitions of AIDS-Defining Conditions