TY - JOUR
T1 - The impact of cirrhosis on CD4+ T cell counts in HIV-seronegative patients
AU - McGovern, Barbara H.
AU - Golan, Yoav
AU - Lopez, Marvin
AU - Pratt, Daniel
AU - Lawton, Angela
AU - Moore, Grayson
AU - Epstein, Mark
AU - Knox, Tamsin A.
N1 - Funding Information:
Financial support. General Clinical Research Center, funded by the National Center for Research Resources of the National Institutes of Health (MO1-RR00054). Potential conflicts of interest. All authors: no conflicts.
PY - 2007/2/1
Y1 - 2007/2/1
N2 - 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/mm3, 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.
AB - 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/mm3, 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.
UR - http://www.scopus.com/inward/record.url?scp=33846460818&partnerID=8YFLogxK
U2 - 10.1086/509580
DO - 10.1086/509580
M3 - Article
C2 - 17205454
AN - SCOPUS:33846460818
SN - 1058-4838
VL - 44
SP - 431
EP - 437
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -