Splenectomy in patients with AIDS and AIDS-related complex

Kemeny, Margaret; Cooke, Virginia; Melester, Timothy; Halperin, Ira; Burchell, Albert R.; Yee, John; Mills, Catherine M.

doi:10.1097/00002030-199308000-00006

Cited by 13 publications

(7 citation statements)

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“…Among the factors that appear to temporarily alter disease progression is splenectomy, performed in many patients with AIDS who develop hypersplenism. Reports based on a number of groups of HIV-1-infected individuals who have undergone splenectomy suggest a protracted course of disease with at least a transient increase in CD4+ and CD8+ T-lymphocyte counts and percentages [36][37][38][39][56][57][58]. Oksenhendler et al [57] studied the course of 68 HIV-1-infected patients prospectively with severe immune thrombocytopenia (ITP) who underwent splenectomy 2-41 months (mean of 10 months) after ITP was diagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…In their patients, a three-year follow-up showed either minimal or no further increase in CD4+ T-lymphocytes after the initial postsplenectomy rise. Kemeny et al and others [37,38] found that splenectomy reversed the patients' thrombocytopenia and there was no accelerated progression to AIDS. Tunkel et al [39], in a retrospective study, reviewed the records of five HIV-1-infected patients who underwent splenectomy for HIV-1-associated thrombocytopenia and splenomegaly.…”

Section: Introductionmentioning

confidence: 94%

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Viral Burden and Disease Progression in HIV-1–Infected Patients with Sickle Cell Anemia

et al. 1998

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The spleen and lymph nodes are major sites of human immunodeficiency virus type 1 (HIV-1) replication, mutation, and genetic variation in vivo. If a major portion of the lymphatic tissue, such as the spleen, is removed or otherwise is unavailable for invasion by the HIV-1 virus, will the course of the infection be altered, resulting in a prolonged symptom-free interval or even increased survival? The spleen of most adults with sickle cell anemia (SS) is nonfunctional due to recurrent episodes of microinfarction. If autosplenectomized SS patients are exposed to HIV-1, they may be ideal candidates to examine the question of whether absence of splenic function at the time of infection will positively alter the course of HIV-1-related disease. All SS patients with a diagnosis of HIV-1 infection at five university sickle cell centers were included in the patient cohort. Patients in active treatment or in follow-up (group A, n = 11) underwent a series of quantitative viral studies to determine their HIV-1 viral burden. The studies included the branched-DNA signal amplification assay, quantitative DNA-polymerase chain reaction (PCR), quantitative reverse transcription (RT)-initiated-PCR, and in situ PCR. All patients who died of the complications of the acquired immunodeficiency syndrome (AIDS) or of SS, lost to follow-up, or were otherwise unavailable for study (Group B: n = 7) were included in the total patient group. None of the patients in group B underwent quantitative viral studies. In addition, a control population (group C, n = 36) of HIV-1-infected African Americans without SS, of similar age and gender to the SS patients, were compared with the study population for outcomes. In eight of 11 active patients (group A), the CD4+ T-lymphocyte counts were normal and viral burdens were low for an average of 10.25 years following diagnosis. These eight patients all from group A were the only long-term nonprogressors (44%) among a total of 18 SS patients (groups A and B). In group C (control), only five patients of 36 were long-term nonprogressors (13.9%). Five patients (28%) of the total SS group (groups A and B) succumbed to AIDS. One of the five was from Group A. The evaluation of a limited number of adult individuals suggests that a significant proportion of HIV-1-seropositive SS patients (44%) may be asymptomatic long-term nonprogressors. In these patients, the CD4+ T-lymphocyte counts remained high and their viral burdens were remarkably lower than in non-SS HIV-1-seropositive individuals. Whereas this study does not prove an "autosplenectomy" hypothesis, it suggests that in patients with both SS and HIV-1 infection, the retroviral disease may be ameliorated by host factors of which absence of splenic function prior to HIV-1 infection may be one.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Viral Burden and Disease Progression in HIV-1–Infected Patients with Sickle Cell Anemia

et al. 1998

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“…Moreover, splenectomy has been reported to result in increased counts of CD3, CD4 and CD8 lymphocyte numbers [79]. As a result, some view splenectomy as a successful therapeutic method [86][87][88].…”

Section: Splenectomymentioning

confidence: 99%

Thrombocytopenia in HIV Disease: Clinical Relevance, Physiopathology and Management

Míguez‐Burbano¹,

Jackson²,

Hadrigan³

2005

CMCCHA

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HIV infection is associated with a myriad of hematopoietic abnormalities. Thrombocytopenia (TCP), the condition in which platelet counts fall below 150x10(3)/mm3 in two or more consecutive platelet counts, is a condition frequently seen in HIV infected individuals regardless of HIV status, gender, or age. Having recently been associated with rapid disease progression, and by complicating the management of AIDS patients, thrombocytopenia has become a medical challenge, highlighting the urgent need for evidence-based treatment protocols in this area. Due to the physiopathology of HIV, therapeutic options currently available for TCP in this already vulnerable population are severely limited. Whereas clinicians often intervene to prevent life-threatening, thrombocytopenia-associated outcomes in the general population, there is no intervention protocol: for the HIV subjects. Management of the condition seems to be the norm for these individuals. As a result, thrombocytopenia in HIV is a subject that is in urgent need of re-examination. In this review, the importance of thrombocytopenia and current knowledge regarding the physiopathology of HIV-associated thrombocytopenia is discussed, and an overview of current and under-investigation treatment approaches to this adverse hematological condition is provided.

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“…Another risk factor is neutropenia, which may result from direct retroviral infection, the use of antiretroviral and other drug therapy, systemic opportunistic infections and autoimmune mechanisms [17]. Splenectomy [18,19], previous pneumonia, whatever the cause [8], smoking illicit drugs [8] and low Karnofsky score [14] have also been associated with bacterial pneumonia.…”

Section: Incidence Of Pyogenic Bacterial Lower Respiratory Tract Infementioning

confidence: 99%

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

Mayaud

Parrot²,

Cadranel³

2002

Eur Respir J

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In human immunodeficiency virus (HIV)-infected patients, bacterial lower respiratory tract infections are the most frequent respiratory diseases. They are frequently the first clinical manifestation of HIV infection.The incidence and severity of bacterial lower respiratory tract infections increase with the degree of immunosuppression. At the acquired immune deficiency syndrome (AIDS) stage, the responsible bacteria and clinical presentation may be atypical. Bacterial pneumonia may be fatal, particularly in AIDS patients, and its occurrence is predictive of a reduced survival time.Pneumococcal vaccine is recommended in patients with a CD4 T‐lymphocyte count of >200 cells·mm−3and cotrimoxazole (trimethoprim/sulfamethoxazole) in patients with a CD4 T‐lymphocyte count of <200 cells·mm−3. Unfortunately, such prophylaxis remains insufficiently prescribed and its protective effect is limited.Highly active antiretroviral treatment has dramatically reduced the incidence of lower respiratory tract infection due toPseudomonasaeruginosaand opportunistic bacteria. In contrast, successful highly active antiretroviral therapy slightly decreased the risk of bacterial pneumonia due to usual bacteria, even in patients on successful highly active antiretroviral therapy.

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Splenectomy in patients with AIDS and AIDS-related complex

Cited by 13 publications

References 0 publications

Viral Burden and Disease Progression in HIV-1–Infected Patients with Sickle Cell Anemia

Viral Burden and Disease Progression in HIV-1–Infected Patients with Sickle Cell Anemia

Thrombocytopenia in HIV Disease: Clinical Relevance, Physiopathology and Management

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

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