Meira D G, Lorand-Metze I, Toro A D C, Silva M T N, Vilela M M S
Center for Investigation in Pediatrics, Pediatrics Department, State University of Campinas Medical School-UNICAMP, São Paulo, Brazil.
J Trop Pediatr. 2005 Apr;51(2):114-9. doi: 10.1093/tropej/fmh096.
HIV infection is associated with numerous abnormalities affecting both the myeloid and lymphoid lineages. We studied the features associated with peripheral cytopenias as the first sign of HIV infection in children. Peripheral blood (PB) counts, PB and bone marrow (BM) lymphocyte subsets, as well as viral load and serum levels of ferritin, vitamin B12, and folic acid were determined. Five children were naive of treatment (Group 1) and three were under HAART (Group 2). In Group 1 all patients had anemia of chronic disease. One had a bone marrow culture positive for Mycobacterium avium intracellulare and pancytopenia. Besides this, neutropenia and thrombocytopenia were seen in one patient each. In Group 2 anemia was found in all, neutropenia in one, and thrombocytopenia in two patients. Peripheral blood cytopenias were due to HAART toxicity in one patient. In the other two they were due to iron or folate deficiency. Bone marrow cytology showed cell abnormalities mainly in granulocytic precursors and megakaryocytes. All except two (taking HAART) patients had a high viral load. There was a straight correlation between viral load in PB and bone marrow. Viral load was correlated with peripheral CD4 but not with CD8 lymphocytes. A decrease in bone marrow B lymphocytes was seen in all patients. The introduction of HAART improved peripheral cytopenias. Bone marrow examination was useful for determining the etiology of the cytopenias and for detection of opportunistic infection. Hemopoietic cell abnormalities were similar to those seen in adults and indicative of HIV infection.
HIV感染与影响髓系和淋巴系的众多异常情况相关。我们研究了儿童HIV感染的首个迹象——外周血细胞减少相关的特征。测定了外周血（PB）计数、PB和骨髓（BM）淋巴细胞亚群，以及病毒载量和铁蛋白、维生素B12及叶酸的血清水平。5名儿童未接受治疗（第1组），3名儿童正在接受高效抗逆转录病毒治疗（HAART，第2组）。第1组所有患者均患有慢性病贫血。1例患者骨髓培养鸟分枝杆菌胞内亚种呈阳性且全血细胞减少。除此之外，各有1例患者出现中性粒细胞减少和血小板减少。第2组所有患者均发现贫血，1例中性粒细胞减少，2例血小板减少。1例患者外周血细胞减少是由于HAART毒性所致。另外2例是由于铁或叶酸缺乏。骨髓细胞学显示细胞异常主要见于粒细胞前体和巨核细胞。除2例（接受HAART治疗）患者外，所有患者病毒载量均较高。PB和骨髓中的病毒载量呈直接相关。病毒载量与外周CD4淋巴细胞相关，但与CD8淋巴细胞无关。所有患者骨髓B淋巴细胞均减少。HAART的应用改善了外周血细胞减少情况。骨髓检查有助于确定血细胞减少的病因及检测机会性感染。造血细胞异常与成人所见相似，提示HIV感染。
