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

<b><i>Objective:</i></b> The objective of this study was to describe the clinical and microbiologic characteristics of adult patients with HIV infection and splenomegaly treated with splenectomy. <b><i>Methods:</i></b> We conducted a retrospective study, including patients with the diagnosis of HIV and splenomegaly treated with splenectomy between 2005 and 2023. <b><i>Results:</i></b> 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). <b><i>Conclusions:</i></b> 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.