Surgical treatment of HIV-related immune thrombocytopenia

Immune related thrombocytopenia has been described extensively in patients infected with the human immunodeficiency virus (HIV). The efficacy and safe ty of splenectomy performed in 21 patients affected with HIV-related immune thrombocytopenia (platelet count less than 50,000/mm(3)); between 1992 and 1996, were evaluated. All the patients were symptomatic and had failed med ical therapy. Nine of them were affected with acquired immune deficiency sy ndrome (AIDS), whereas 12 were HIV-positive (non-AIDS). In all the patients , a pre-operative bone marrow biopsy revealed increased megakaryocytes. FoI low-up ranged from 5-16 months. The response rate to splenectomy (platelet count greater than 100,000/mm(3)) in the AIDS group was 83%, as opposed to 100% in the HIV-positive (non-AIDS) group. During the follow-up period, 19 of the 21 patients maintained platelet counts greater than 98,000/mm(3); of the two non-responders, one patient expired 3 weeks after surgery, and a s econd patient had never responded. None of the HIV-positive (non-AIDS) pati ents developed AIDS during the follow-up period. All the complications obse rved (24%) were treated without sequelae. Based on these data, splenectomy can be considered safe and effective in treating patients with symptomatic HIV-related thrombocytopenia, when medical therapy has failed. Moreover, sp lenectomy did not appear to adversely affect the rate of conversion from th e HIV-positive to the AIDS status, nor did it accelerate the progression of the disease in patients already diagnosed with AIDS.