An HIV-infected patient may develop several bone marrow disorders including an absolute neutropenia. Identification of the cause is important in order to develop an appropriate care plan.
Differential diagnosis of neutropenia in a patient with HIV:
(1) HIV-related myelosuppression
(2) opportunistic infection involving the bone marrow:
(2a) CMV
(2b) fungal infection (Cryptococcus neoformans, Histoplasma capsulatum, etc)
(2c) mycobacterial infection (M. tuberculosis, M. avium-intracellulare complex, etc).
(2d) other
(3) Hodgkin's disease or malignant non-Hodgkin's lymphoma
(4) metastatic carcinoma
(5) malnutrition and/or vitamin deficiency
(6) drug-induced myelosuppression from medications used to treat other infections
(6a) therapy for HCV disease (ribavirin, interferon alpha)
(6b) therapy for CMV
(6c) therapy for Pneumocystis
(6d) therapy for toxoplasmsosis
(7) drug-induced myelosuppression secondary to chemotherapy for malignancy
(8) drug-induced myelosuppression due to antiretroviral medications (zidovudine, stavudine, other)
(9) marked splenomegaly with hypersplenism
