SPLENECTOMY FOR HIV-RELATED IMMUNE THROMBOCYTOPENIA - COMPARISON WITHRESULTS OF SPLENECTOMY FOR NON-HIV IMMUNE THROMBOCYTOPENIC PURPURA

Objective: To determine the effectiveness and safety of splenectomy fo r patients with human immunodeficiency virus (HIV)-related immune thro mbocytopenia, using the results of splenectomy for patients with non-H IV immune thrombocytopenic purpura as a control group for comparison. Design: Retrospective study. Setting: Tertiary care university hospita l. Patients: Fourteen patients who underwent splenectomy for symptomat ic, medically refractory HIV-related immune thrombocytopenia at this h ospital from 1988 to 1997. During the same period, 20 patients had spl enectomy for treatment of non-HIV immune thrombocytopenic purpura. Int ervention: Splenectomy. Main Outcome Measures: Platelet response, need for postsplenectomy medical therapy, progression of HIV disease, and complications. Results: All patients with HIV-related thrombocytopenia had a complete early platelet response to splenectomy, with an elevat ion of the platelet count to greater than 100 x 10(9)/L. After a media n follow-up of 26.5 months, all but 1 patient had a sustained complete remission with no need for medical therapy for thrombocytopenia. Sple nectomy was more effective in the HIV-related thrombocytopenia group t han in the non-HIV immune thrombocytopenic purpura group, with signifi cantly higher platelet counts at 1 week and 1 month after splenectomy in the HIV group (t test, P = .02 and P = .009, respectively). There w ere significantly fewer patients needing medical therapy for thrombocy topenia after splenectomy in the HIV group (chi(2) test, P = .02). The re were no remarkable short-or long-term complications in the patients with HIV infection, including no overwhelming postsplenectomy infecti ons. Three patients have died, and 2 patients have developed AIDS sinc e operation. Conclusions: Splenectomy is effective treatment for patie nts with symptomatic HIV-related thrombocytopenia that is resistant to medical therapy. The effectiveness of this treatment suggests that th e predominant mechanism of thrombocytopenia in HIV-infected patients i s increased destruction of platelets because of platelet-associated im munoproteins.