1220 Howell-Jolly Body-Like Inclusions in the Neutrophils of HIV Positive Patients Are Associated with Low CD4 Counts DL Scurlock, A Wahed. Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Health Science Center Houston, Houston, TX. Background: Howell-Jolly body-like inclusions are discrete intracytoplasmic inclusions which have been previously observed in the neutrophils of HIV positive individuals. The inclusions are morphologically and structurally similar to red blood cell Howell-Jolly bodies; consisting of remnant nuclear material and appearing as small, densely basophilic inclusions. Little is known of their clinical significance, although it has been suggested that the appearance of Howell-Jolly body-like inclusions is related to antiviral medications. We evaluated the incidence of the inclusions in HIV positive individuals and correlated these results with clinical parameters including CD4 count, which has not previously been reported. Design: Peripheral blood smears from 18 consecutive HIV positive patients and 20 consecutive HIV negative patients who underwent bone marrow biopsy were reviewed. The entire thin portion of the peripheral blood smear was reviewed for the presence of neutrophil cytoplasmic inclusions. A Feulgen reaction was performed to confirm that the inclusions consisted of nuclear material. Concurrent clinical information was collected including: HIV status, therapeutic regimen, viral load, and CD4 count. Results: Of the 18 HIV positive patients, neutrophil inclusions were identified in 10 individuals (55%). CD4 counts were significantly lower (P<0.05) in inclusion-positive cases (mean 12.86 cells/mm3) versus the inclusion-negative cases (mean 226.7 cells/ mm3). HIV RNA viral loads were not significantly different between the inclusionpositive (mean 178,200 copies/ml) and inclusion-negative groups (mean 119,400 copies/ml). Antiretroviral therapy did not show a statistical relationship with the presence of inclusions (30% of inclusion-positive vs. 63% of inclusion-negative receiving antiretroviral therapy). No inclusions were identified in the 20 HIV negative patients. Conclusions: The findings suggest that Howell-Jolly body-like inclusions are not uncommon in HIV positive individuals. It appears that the inclusions are not related to antiviral medication or viral load. A relationship does appear to exist between lower CD4 counts and the appearance of inclusions. This shows that in HIV positive individuals, Howell-Jolly body-like inclusions correlate with the degree of immune suppression.