INCREASE IN CD4 LYMPHOCYTE COUNTS AFTER SPLENECTOMY IN HIV-INFECTED PATIENTS

The records were reviewed of five human immunodeficiency virus (HIV) t ype 1-infected patients who underwent splenectomy, four for HIV-associ ated thrombocytopenia and one for gastric compression secondary to spl enomegaly. After splenectomy, the four adult patients all had marked, sustained increases in their absolute CD4 lymphocyte counts; greater i ncreases were observed in CD8 lymphocyte counts, accounting for decrea ses in the CD4:CD8 ratios. In patient 5 (one of triplets, all of whom were infected with HIV after a blood transfusion), absolute CD4 lympho cyte counts were stabilized after splenectomy; the other siblings mani fested a decline in CD4 counts, which was associated with a delay in p hysical development and recurrent episodes of varicella. Immunohistoch emical staining of spleen sections demonstrated significantly higher n umbers of CD4 cells in splenic tissue from HIV-infected patients than from patients splenectomized secondary to trauma (2,070 +/- 284 vs. 96 2 +/- 296; p = 0.025). In addition, the HIV-infected patients had sign ificantly higher percentages of CD4 lymphocytes in splenic tissue than in peripheral blood (49.3 +/- 11.0 vs. 20.3 +/- 7.9; p = 0.005), sugg esting that CD4 cells were sequestered in the spleens of these patient s. These findings have implications for the management of splenectomiz ed HIV-infected patients with regard to optimal timing of initiation o f zidovudine therapy and for prophylaxis of Pneumocystis carinii pneum onia.