Retrospective comparison of cytological and histological bone marrow morphology in adult antiretroviral-naïve and antiretroviral experienced human immunodeficiency virus-infected patients with peripheral blood cytopaenias

Abstract

A cohort of human immunodeficiency virus (HIV)-positive patients presenting to a quaternary hospital in KwaZulu-Natal, South Africa over a period of one year was identified and morphological analyses of their bone marrow aspirates and trephine biopsies (BMAT) undertaken. Aim: To compare and contrast the bone marrow morphological features of antiretroviral (ARV)-naïve and ARV-experienced HIV-positive population with cytopaenias; correlate the findings with CD4 counts; and, draw conclusions on whether ARV are associated with specific bone marrow (BM) findings. Method: Aspirate and trephine biopsy examinations to assess dysplasia of cell lineages, architectural changes, granulomas or infiltrates were performed by light microscopy. Results: 74 BMAT were examined, of which 24 were from the ARV-naïve cohort and 50 from ARV-treated cohort. Within granulomas, higher rates of marrow infiltration by acid-fast bacilli was present in the ARV-naïve cohort than the ARV-experienced cohort (6/10 (60%) versus 9/26 (35%), respectively). Higher rates of pure red cell aplasia (PRCA) were detected in the ARV-experienced than the ARV-naive cohort (14% versus 4%, respectively). No difference was seen in morphological features and overall dysplasia rates (70% and 71% of ARV-naïve and ARV-experienced cohort, respectively). At CD4 > 200 cells/ul, higher rates of dysplasia were seen in the ARV-naïve cohort (3/3 (100%) than in the ARV-experienced cohort (13/20 (65%)). Conclusion: Similar dysplasia rates and morphological features in both cohorts suggest ARVs do not cause myelodysplasia. BM tuberculosis is more frequently detected in granulomas of ARV-naïve than ARV-experienced samples. ARVs are implicated in causation of PRCA.

Diagnostic outcomes of bone marrow aspirate and trephine biopsies performed at a hospital in KwaZulu-Natal, South Africa

“…15,16 Cytopenias are well documented, multifactorial complications of HIV infection. 4,5 Our study demonstrated that 46% of HIV-positive participants had one or more forms of cytopenia: anaemia, pancytopenia, bicytopenia and thrombocytopenia. A study conducted in Uganda demonstrated that 65% of antiretroviral-therapynaïve HIV-positive participants had a form of cytopenia.…”

“…For this reason our study reported low rates (4/120) of tuberculosis diagnosis on BMAT when compared to other South African studies that demonstrated higher tuberculosis diagnoses on BMAT samples. 4,14 These studies included: a study that looked at 410 case samples of adult and paediatric BMAT submitted for excluding tuberculosis, which showed a 32.5% tuberculosis prevalence, and a study that assessed bone marrow morphology in 74 patients, in which comparing morphology between patients on antiretroviral therapy and patients naïve to antiretroviral therapy showed a 31% tuberculosis prevalance. 4,14 Both of these studies had higher tuberculosis prevalence due to their study populations being cases with high risk for tuberculosis.…”

“…21 Our HIV and DLBCL burdens are in keeping with the current rates in most countries throughout the world. 4,21 HIV infection was highly prevalent at 81% among the cases that had undergone bone marrow examination for the staging of the DLBCL. This finding about prevalence of HIV infection in cases with DLBCL was similar to results of a study done at a South African hospital in 2016 which reported the prevalence of HIV as 81% in 139 patients with DLBCL.…”

“…3 In 2014, Naidoo et al studied the outcome of histological comparison to cytology in antiretroviral-therapy-naïve vs. antiretroviral-therapy-experienced HIV-positive patients presenting with peripheral blood cytopenias and found higher rates of granulomatous disease and pure red cell aplasia in antiretroviral-therapy-naïve patients. 4 More recently in 2018, in a study conducted by Philips and Opie to assess the use of bone marrow examination in lymphoma sufferers in South Africa, it was shown that out of the 1215 Bone marrow aspiration and trephine (BMAT) records, bone marrow involvement was most commonly present in non-Hodgkin's lymphoma (43.7%), followed by high-grade B subtypes (28.9%) and Hodgkin's lymphoma (35.7%). 5 Background: Bone marrow aspiration and trephine biopsy (BMAT) are widely performed in adults to evaluate haematological and malignant conditions.…”