title: Discordance between CD4+ T-lymphocyte counts and percentages in HIV-infected persons with liver fibrosis.
abstract: BACKGROUND
  Cirrhosis of the liver can induce splenic sequestration of peripheral blood cells, recently suggested to reduce the number but not percentage of circulating CD4(+) T cells in persons uninfected with human immunodeficiency virus (HIV). We investigated whether earlier stages of liver fibrosis prior to cirrhosis were associated with discordance between CD4 count (CD4N) and CD4 percentage (CD4%) in HIV-infected patients.
  
  
  METHODS
  In cross-sectional analysis of 287 HIV-infected participants of the AIDS Linked to the Intravenous Experience cohort, we evaluated CD4N, CD4%, and transient elastography staging of liver fibrosis. High CD4(+) lymphocyte discordance was defined as higher CD4% relative to CD4N based on accepted clinical cutoffs; multivariable logistic regression was used to determine covariates associated with discordance.
  
  
  RESULTS
  Of 287 participants, 99 (34.4%) had high CD4(+) discordance, which increased to 76% of 114 participants with marked lymphopenia (total lymphocyte count [TLC] ≤1200 cells/μL). In multivariable analysis, the odds of having high CD4(+) discordance was increased in persons with significant liver fibrosis compared to those without fibrosis (odds ratio, 1.69; 95% confidence interval [CI], .95-2.96); the odds ratio of discordance increased to 2.66 (95% CI, 1.11-6.40) among the subset of participants with TLC ≤1200 cells/μL. The odds for discordance associated with cirrhosis were of similar magnitude as those observed with significant fibrosis.
  
  
  CONCLUSIONS
  In HIV-infected persons, liver fibrosis is associated with discordant peripheral CD4(+) lymphocyte results, especially in the setting of marked lymphopenia. Clinicians should also consider CD4% when interpreting absolute CD4(+) counts of HIV-infected persons with known or suspected liver disease, particularly if TLC is <1200 cells/μL.
authors.affiliation: Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Cassidy W
authors.initials: CW
authors.lastname: Claassen
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000276:immunology* / Q000473:pathology; D008297:Male