Naked megakaryocyte nuclei as an indicator of human immunodeficiency virus infection

Compact, lobulated megakaryocyte nuclei, apparently denuded of cytoplasm (naked nuclei), have been reported to be markedly increased in the bone marrow of persons infected with human immunodeficiency virus (HIV). We have confirmed this observation and have developed a useful diagnostic index, the naked nucleus ratio, to characterize the bone marrow of individuals who are infected with HIV. The naked nucleus ratio, calculated as the average number of naked nuclei per high-power field divided by the average number of intact megakaryocytes per high-power field, has a sensitivity of 97.9% and a specificity of 96.4% for patients with HIV infection. In our patients with a 62.6% prevalence of HIV infection, the predictive value of a positive test was 97.9% and the predictive value of a negative test was 96.4%. An increase in the naked nucleus ratio above 10%, without specific changes in the bone marrow, should raise or may confirm the suspicion of HIV infection.