title: The impact of cirrhosis on CD4+ T cell counts in HIV-seronegative patients.
abstract: 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.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Jamaica Plain, MA 02130, USA. bmcgovern@tufts-nemc.org
authors.forename: Barbara H
authors.initials: BH
authors.lastname: McGovern
authors.forename: Yoav
authors.initials: Y
authors.lastname: Golan
authors.forename: Marvin
authors.initials: M
authors.lastname: Lopez
authors.forename: Daniel
authors.initials: D
authors.lastname: Pratt
authors.forename: Angela
authors.initials: A
authors.lastname: Lawton
authors.forename: Grayson
authors.initials: G
authors.lastname: Moore
authors.forename: Mark
authors.initials: M
authors.lastname: Epstein
authors.forename: Tamsin A
authors.initials: TA
authors.lastname: Knox
mesh_terms: 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*