Splenectomy Is Safe and Effective in Human Immunodeficiency Virus-Related Immune Thrombocytopenia

Sixty-eight patients, followed in a prospective cohort study of 185 human immunodeficiency virus (HIV)-infected patients with severe immune thrombocytopenia (platelets < 50 × 109/L), underwent splenectomy, 2 to 41 months (median: 10 months) after immune thrombocytopenic purpura (ITP) was diagnosed. The mean platelet count increased from 18×109/L to 223 × 109/L with a persistent increase in 56 (82%). It also led to a significant increase of the mean CD4 cell count from 475 × 106/L to 725 × 106/L within a mean delay of 10 months. In the whole cohort, with a mean follow-up of 63 months (range, 6 to 126), the 5-year estimated rate for progression to acquired immunodeficiency syndrome (AIDS) was 23% (95% confidence interval [Cl], 15% to 31%) and the AIDS-free survival was 69% (95% Cl, 61 % to 77%). To investigate the potential impact of splenectomy, a Cox’s multiple regression model was used; as splenectomy was not randomly assigned, it was incorporated as a time-dependent covariate. After adjustment on the CD4 cell count, no statistically significant differences were observed between the splenectomized and the nonsplenectomized patients: AIDS progression rate (P= 0,23), survival (P= 0,64) and AIDS-free survival (P= 0,72) were not influenced by splenectomy. Splenectomy is both effective and safe in the treatment of severe, refractory ITP associated with HIV infection.