Evolving Indications and Diagnostic Spectrum of Bone Marrow Examination in People with HIV During the Antiretroviral Therapy Era: A 6-Year Retrospective Study

Abstract

With the widespread use of antiretroviral therapy, the clinical spectrum among people with HIV has evolved significantly. This study aims to investigate the dynamic changes in the primary indications and final diagnostic spectrum of bone marrow examinations in this population. We conducted a retrospective analysis of 154 hospitalized individuals with HIV who underwent bone marrow examination at Mengchao Hepatobiliary Hospital of Fujian Medical University, the largest designated HIV/AIDS care hospital in Southeast China, from September 2019 to December 2025. Demographic, laboratory, and pathological data were collected, and participants were stratified into tumor and nontumor groups based on final diagnosis for comparative analysis. Among the indications for bone marrow examination, the proportion of procedures performed due to cytopenia decreased from 55.55% in 2019 to 17.86% in 2025. Conversely, the proportion performed for suspected hematological malignancy or to assess tumor marrow infiltration increased significantly from 11.11% to 60.71%. Final diagnoses revealed that the proportion of malignant tumors increased from 11.11% to 53.57%, whereas the proportion of opportunistic infections showed a declining trend. The Cochran–Armitage trend test confirmed that the proportion of opportunistic infections decreased significantly (p = .002), while the proportion of malignancies increased significantly (p = .002). Compared to the nontumor group, individuals in the tumor group were older, had significantly higher proportions receiving antiretroviral therapy, higher rates of HIV RNA suppression, as well as significantly higher CD4⁺ T-cell counts, CD8⁺ T-cell counts, lymphocyte counts, platelet counts, and lactate dehydrogenase levels. Our findings demonstrate that the clinical indications for bone marrow examination in people with HIV have shifted from the evaluation of traditional opportunistic infections and unexplained cytopenia toward the diagnosis and staging of malignant tumors, particularly hematological malignancies. These results suggest that in the contemporary management of HIV, greater emphasis should be placed on screening for malignancies.