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 safety of splenectomy performed in 21 patients affected with HIV-related immune thrombocytopenia (platelet count less than 50,000/mm3), between 1992 and 1996, were evaluated. All the patients were symptomatic and had failed medical therapy. Nine of them were affected with acquired immune deficiency syndrome (AIDS), whereas 12 were HIV-positive (non-AIDS). In all the patients, a pre-operative bone marrow biopsy revealed increased megakaryocytes. Follow-up ranged from 5-16 months. The response rate to splenectomy (platelet count greater than 100,000/mm3) 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/mm3; of the two non-responders, one patient expired 3 weeks after surgery, and a second patient had never responded. None of the HIV-positive (non-AIDS) patients developed AIDS during the follow-up period. All the complications observed (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, splenectomy did not appear to adversely affect the rate of conversion from the HIV-positive to the AIDS status, nor did it accelerate the progression of the disease in patients already diagnosed with AIDS.
Department of Surgery, Cabrini Medical Center, The Mount Sinai School of Medicine, New York, New York 10003, USA. gorshap@aol.com
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Aboolian
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Ricci
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Shapiro
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Connors
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LaRaja
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology; D000328:Adult; D001772:Blood Cell Count; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013156:Splenectomy; D013921:Thrombocytopenia / Q000209:etiology / Q000276:immunology / Q000601:surgery*