title: Case report: increase in CD4 lymphocyte counts after splenectomy in HIV-infected patients.
abstract: The records were reviewed of five human immunodeficiency virus (HIV) type 1-infected patients who underwent splenectomy, four for HIV-associated thrombocytopenia and one for gastric compression secondary to splenomegaly. After splenectomy, the four adult patients all had marked, sustained increases in their absolute CD4 lymphocyte counts; greater increases were observed in CD8 lymphocyte counts, accounting for decreases in the CD4:CD8 ratios. In patients 5 (one of triplets, all of whom were infected with HIV after a blood transfusion), absolute CD4 lymphocyte counts were stabilized after splenectomy; the other siblings manifested a decline in CD4 counts, which was associated with a delay in physical development and recurrent episodes of varicella. Immunohistochemical staining of spleen sections demonstrated significantly higher numbers of CD4 cells in splenic tissue from HIV-infected patients than from patients splenectomized secondary to trauma (2,070 +/- 284 vs. 962 +/- 296; p = 0.025). In addition, the HIV-infected patients had significantly higher percentages of CD4 lymphocytes in splenic tissue than in peripheral blood (49.3 +/- 11.0 vs. 20.3 +/- 7.9; p = 0.005), suggesting that CD4 cells were sequestered in the spleens of these patients. These findings have implications for the management of splenectomized HIV-infected patients with regard to optimal timing of initiation of zidovudine therapy and for prophylaxis of Pneumocystis carinii pneumonia.
authors.affiliation: Department of Medicine (Infectious Diseases), Medical College of Pennsylvania, Philadelphia 19129.
authors.forename: A R
authors.initials: AR
authors.lastname: Tunkel
authors.forename: B
authors.initials: B
authors.lastname: Kelsall
authors.forename: M F
authors.initials: MF
authors.lastname: Rein
authors.forename: D J
authors.initials: DJ
authors.lastname: Innes
authors.forename: F T
authors.initials: FT
authors.lastname: Saulsbury
authors.forename: K
authors.initials: K
authors.lastname: Vollmer
authors.forename: B
authors.initials: B
authors.lastname: Wispelwey
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology / Q000276:immunology*; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D002648:Child; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007958:Leukocyte Count; D008297:Male; D013154:Spleen / Q000276:immunology; D013156:Splenectomy; D013921:Thrombocytopenia / Q000209:etiology / Q000601:surgery