The impact of cirrhosis on CD4+ T cell counts in HIV-seronegative patients.
BACKGROUND
Studies of the progression liver fibrosis in human immunodeficiency virus (HIV) and hepatitis C virus-coinfected patients suggest that cirrhosis is associated with immunosuppression, as measured by low absolute CD4(+) T cell counts. However, we hypothesized that, in patients with advanced liver disease, low CD4(+) T cell counts may occur secondary to portal hypertension and splenic sequestration, regardless of the presence or absence of HIV infection.


METHODS
Sixty HIV-seronegative outpatients with cirrhosis were enrolled during the period 2001-2003 in a prospective, cross-sectional study of the association between liver disease and CD4(+) T cell counts and percentages. Demographic characteristics, liver disease-related characteristics, and laboratory results--including CD4(+) T cell parameters--were collected.


RESULTS
A total of 39 patients (65%) had a low CD4(+) T cell count; 26 patients (43%) and 4 patients (7%) had CD4(+) T cell counts <350 and <200 cells/mm(3), respectively. Abnormal CD4(+) T cell counts were associated with splenomegaly (P=.03), thrombocytopenia (P=.002), and leukopenia (P<.001). The percentage of CD4(+) T cells was normal in 95% of patients who had a low absolute CD4(+) T cell count. CD4(+) T cell counts were significantly lower among cirrhotic patients than among 7638 HIV-seronegative historic control subjects without liver disease.


CONCLUSIONS
Cirrhosis is associated with low CD4(+) T cell counts in the absence of HIV infection. Discordance between low absolute CD4(+) T cell counts and normal CD4(+) T cell percentages may be attributable to portal hypertension and splenic sequestration. Our findings have significant implications for the use and interpretation of absolute CD4(+) T cell counts in HIV-infected patients with advanced liver disease.
McGovern
Barbara H
BH
Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Jamaica Plain, MA 02130, USA. bmcgovern@tufts-nemc.org
Golan
Yoav
Y
Lopez
Marvin
M
Pratt
Daniel
D
Lawton
Angela
A
Moore
Grayson
G
Epstein
Mark
M
Knox
Tamsin A
TA
D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000276:immunology; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013163:Splenomegaly / Q000097:blood*