Splenectomy for the Treatment of Splenomegaly in People Living with HIV: An Uncommon Complication.

Objective

The objective of this study was to describe the clinical and microbiologic characteristics of adult patients with HIV infection and splenomegaly treated with splenectomy.

Methods

We conducted a retrospective study, including patients with the diagnosis of HIV and splenomegaly treated with splenectomy between 2005 and 2023.

Results

We included 20 patients with a mean age of 36 years (±2), with a predominance of males (n = 18). Some patients had more than one condition associated with splenomegaly. The following were considered as the indication for splenectomy: Splenic abscesses in 13 (65%), refractory thrombocytopenia in 9 (45%), symptomatic splenomegaly in 5 (25%), and splenic lymphoma in 1 (5%). After operation, spleen samples were sent for microbiology culture, displaying the invasion of bacteria in 11 (55%), fungi in 8 (40%), and viruses in 8 (40%). When evaluating the indications for splenectomy between groups, splenic abscesses were more present in those patients without active treatment (83% vs. 38%, p = 0.035), whereas symptomatic splenomegaly presented more frequently in those with active antiretroviral therapy (ART; 63% vs. 0%, p = 0.004).

Conclusions

The cornerstone of treatment for patients with splenomegaly should initially focus on adherence to ART and addressing the underlying cause. However, when the condition is refractory splenectomy may be indicated.