ObjectiveTo study the effect of splenectomy in HIV-infected patients.DesignA retrospective chart review of patients admitted to St Vincent's Hospital who had splenectomies and were HIV-positive.SettingAll patients were treated at St Vincent's Hospital, New York City, New York, USA.PatientsOnly patients who were HIV-positive and who had had a splenectomy at St Vincent's Hospital were included.InterventionAll patients had a splenectomy.Main outcome measuresThe effect of the splenectomy in these HIV-positive patients was studied with respect to their operative morbidity and mortality, platelet counts, overall survival and the development of new opportunistic infections.ResultsAll patients who did not have AIDS but did have thrombocytopenia responded to splenectomy in terms of their thrombocytopenia. None of them had an accelerated progression to AIDS. Most patients with AIDS and thrombocytopenia responded to splenectomy in terms of correcting their thrombocytopenia.ConclusionsSplenectomy as a treatment for thrombocytopenia is successful not only in HIV-positive patients without AIDS, but also in AIDS patients. However, in patients with disseminated Kaposi's sarcoma orMycobacterium avium intracellulare, splenectomy may not be a factor for survival.