HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS


  • Hemalatha Kuppan Department of Pathology, Apollo Hospital, Chennai, Tamil Nadu, India
  • Vanishri Ashok Hematology Section, Central Laboratory, Kasturba Medical College Hospitals, Ambedkar Circle, Mangalore, Karnataka, India
  • Sridevi Hanaganahalli Basavaiah Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104
  • Urmila Niranjan Khadilkar Hematology Section, Central Laboratory, Kasturba Medical College Hospitals, Ambedkar Circle, Mangalore, Karnataka, India
  • Nirupama Murali Department of Pathology, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Devarakaggalahalli, Harohalli, Kanakapura Road, Ramanagara Dt., Karnataka - 562 112



Dysplasia, anemia, HIV, thrombocytopenia, bone marrow


Introduction and Aim: Haematological manifestations in HIV disease is common and can happen at any phase during the disease course. Anemia and thrombocytopenia are the most frequent hematologic abnormalities and are associated with high morbidity and mortality. The objective of current study was to observe and analyse various spectrum of bone marrow changes and haematological abnormalities in HIV/AIDS and to correlate findings with CD4 count.


Material and Methods: A total of 44 patients over a period of 5 years were included. Clinical findings, hematological profile, bone-marrow aspirate, biopsy findings and CD4 count of these patients were documented. The association between absolute lymphocyte count (ALC) and CD4 count were further established.


Results: The most common clinical indication for bone-marrow aspiration and trephine biopsy was pancytopenia (47.3%), pyrexia of unknown origin (15.1%), and unresolving hepatosplenomegaly (13.6%). Anemia (72.7%) was commonest haematological abnormality. Bone marrow aspirate was normocellular in majority of patients. Marrow findings were correlated with CD4 count and were found to be statistically significant. Tri-lineage dysplasia was observed in 9.1% of patients, and megakaryocytic dysplasia being the commonest(61.4%). Histiocytic aggregates (27.3%) were noted among which 6.8% showed acid fast bacilli in Ziehl-Neelsen stain. Fungal stains revealed histoplasmosis in 4.5% patients.


Conclusion: There was a strong negative association between presence of anemia and dysplasia and CD4 count. When CD4 was <200/µL and ALC<1000/mm3, presence of anemia and dysplasia affecting various cell lines were commonly observed; therefore, can be used as indicators to assess the severity of the disease.

Author Biography

Vanishri Ashok, Hematology Section, Central Laboratory, Kasturba Medical College Hospitals, Ambedkar Circle, Mangalore, Karnataka, India

Department of Hematology


Noy, A., Gulick, R. M. Acquired immunodeficiency syndrome. In: Greer JP, Arber DA, Glader B, List AF, (eds). Wintrobe’s Clinical hematology. 13th edition, Philadelphia, Wolters Kluwer, 2014: p1358-1364.

Tripathi, A. K., Misra, R., Kalra, P., Gupta, N., Ahmad, R. Bone marrow abnormalities in HIV disease. J Assoc Physicians India 2005; 53: 705-710.

WHO Annual report (last update on November 30 2020). Available from: [Last accessed on 2021 May 24].

NACO Annual report 2019-2020 (last update on July 21 2020).

Parintha, S. S., Kulkarni, M. H. Haematological changes in HIV infection with correlation to CD4 count. Australas Med J. 2012; 5: 157-162.

O’Malley, D. P., Orazi, A. Bone Marrow Abnormalities associated with Non-neoplastic Conditions. In: Hsi ED, (eds). Hematopathology, Philadelphia, Churchill Livingstone Elsevier. 2007: 173-198.

McNamara, L. A., Collins, K. L. Hematopoietic stem/precursor cells as HIV reservoirs. Current Opinion in HIV and AIDS. 2011; 6: 43-48.

Khandekar, M. M., Deshmukh, S. D., Holla, V. V., Kakrani, A. L., Sangale, S. A., Habbu, A. A., et al., Profile of bone marrow examination in HIV/AIDS patients to detect opportunistic infections, especially tuberculosis. Indian J Pathol Microbiol 2005; 48: 7-12.

Tsukamoto, T. Hematopoietic Stem/Progenitor Cells and the Pathogenesis of HIV/AIDS. Front Cell Infect Microbiol. 2020 Feb 21; 10: 60.

Kotwal, C. J., Singh, M. V. A study of haematological and bone marrow changes in symptomatic patients with human immune deficiency virus infection with special mention of functional iron deficiency, anemia of critically ill and haemophagocytic lymphohistiocytosis. Med J Armed Forces 2013; 69: 319-325.

Santos, E. S., Raez, L. E., Eckardt, P., DeCesare, T., Whitcomb, C. C., Byrne, Jr., G. E. The utility of a bone marrow biopsy in diagnosing the source of fever of unknown origin in patients with AIDS. J Acquir Immune Defic Syndr 2004; 37: 1599-1603.

Pande, A., Bhattacharyya, M., Pain, S., Samanta, A. Study of bone marrow changes in antiretroviral naïve human immunodeficiency virus infected anemic patients. Indian J Pathol Microbiol 2011; 54: 542-546.

Attili, S. V. S., Singh, V. P., Rai, M., Varma, D. V., Gulati, A. K., Sundar, S. Hematological profile of HIV patients in relation to immune status - a hospital-based cohort from Varanasi, North India. Turk J Hematol. 2008; 25: 13-19.

Dhurve, S. A., Dhurve, S. A. Bone Marrow Abnormalities in HIV Disease. Mediterr J Hematol Infect Dis. 2013; 5910: e2013033.

Rudresh, K., Mysorekar, T.M.A.V.V., Modepalli, N., Ahuja, A. Bone marrow study in patients with Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome. Brunei Int Med J. 2011; 7: 148-156.

Agrawal, P. B., Rane, S. R., Jadhav, M. V. Absolute Lymphocyte Count as a Surrogate Marker of CD4 Count in Monitoring HIV Infected Individuals: A Prospective Study. J Clin Diagn Res. 2016 May; 10(5): EC17-19.




How to Cite

Kuppan H, Ashok V, Hanaganahalli Basavaiah S, Niranjan Khadilkar U, Murali N. HIV Myelopathy- A cross-sectional study of constellation of bone marrow findings in HIV/AIDS. Biomedicine [Internet]. 2021Dec.31 [cited 2022Jan.20];41(4):815-20. Available from:



Original Research Articles