Bernard N F, Chernoff D N, Tsoukas C M
Immunodeficiency Treatment Center, McGill University Medical Center, Montreal, Quebec, Canada.
J Hum Virol. 1998 Jul-Aug;1(5):338-45.
In previous studies we have shown that removal of the spleen in HIV-infected people during the asymptomatic phase of disease results in slower time to AIDS and may also result in improved survival. In this paper, we examine whether splenectomy affects lymphocyte counts, T-cell subsets, and HIV plasma viremia in a manner that could explain the clinical benefits associated with this intervention.
10 HIV-infected patients who underwent splenectomy and 23 HIV-infected controls with idiopathic thrombocytopenia purpura who did not undergo splenectomy were studied. These groups were compared for changes in cell subpopulations and HIV plasma viremia.
Splenectomy resulted in increases in absolute lymphocyte numbers with rises in both CD4 and CD8 counts, whereas CD4 and CD8 percentage levels remained unchanged. In controls, absolute and percentage CD4+ T-cell counts declined with time from date of HIV infection. Plasma viremia decreased more than threefold, the limit of biologic variation, after splenectomy in 4 of 9 subjects and in only 1 of 18 controls. The proportion of subjects exhibiting reduced viremia following splenectomy was greater than that in HIV-infected patients that did not undergo splenectomy (chi 2 test, P = .015).
Improved survival and time to AIDS in splenectomized HIV-infected patients is associated with temporary reduction of plasma viremia and increase in absolute CD4 and CD8 counts. These effects could not be attributed to antiretroviral therapy because subjects were either untreated or treated with antiretroviral monotherapy during the observation period. These observations may have importance in the understanding of T-cell dynamics and the potential for splenectomy as an HIV reservoir-debulking procedure.
在先前的研究中我们已经表明，在疾病无症状期对感染HIV的人进行脾脏切除会使发展至艾滋病的时间延长，并且可能还会提高生存率。在本文中，我们研究脾脏切除术是否会以一种能够解释该干预措施相关临床益处的方式影响淋巴细胞计数、T细胞亚群以及HIV血浆病毒血症。
对10例接受脾脏切除术的HIV感染患者和23例未接受脾脏切除术的患有特发性血小板减少性紫癜的HIV感染对照者进行研究。比较这些组在细胞亚群和HIV血浆病毒血症方面的变化。
脾脏切除导致绝对淋巴细胞数量增加，CD4和CD8计数均升高，而CD4和CD8百分比水平保持不变。在对照组中，自HIV感染之日起，绝对CD4 + T细胞计数和百分比随时间下降。9名受试者中有4名在脾脏切除术后血浆病毒血症下降超过三倍，即生物学变异限度，而18名对照者中只有1名出现这种情况。脾脏切除术后病毒血症降低的受试者比例高于未接受脾脏切除术的HIV感染患者（卡方检验，P = 0.015）。
接受脾脏切除术的HIV感染患者生存率提高以及发展至艾滋病的时间延长与血浆病毒血症的暂时降低以及绝对CD4和CD8计数增加有关。这些效应不能归因于抗逆转录病毒疗法，因为在观察期内受试者要么未接受治疗，要么接受抗逆转录病毒单药治疗。这些观察结果对于理解T细胞动态以及脾脏切除术作为一种减少HIV储存库的方法的潜力可能具有重要意义。
