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1 February 2007

Volume 44, Number 3
Clinical Infectious Diseases 2007;44:431–437
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4403-0021$15.00
DOI: 10.1086/509580
HIV/AIDS MAJOR ARTICLE

The Impact of Cirrhosis on CD4+ T Cell Counts in HIV‐Seronegative Patients

Barbara H. McGovern,1

Yoav Golan,1

Marvin Lopez,2

Daniel Pratt,2

Angela Lawton,1

Grayson Moore,1

Mark Epstein,2 and

Tamsin A. Knox2

Divisions of 1Geographic Medicine and Infectious Diseases and 2Gastroenterology, Tufts–New England Medical Center, Boston, Massachusetts

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 ( ), thrombocytopenia ( ), and leukopenia ( ). 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.

Received 29 June 2006; accepted 15 August 2006; electronically published 21 December 2006.

  • (See the editorial commentary by Gandhi on pages 438–40)

Reprints or correspondence: Dr. Barbara McGovern, Tufts University School of Medicine, Lemuel Shattuck Hospital, Div. of Infectious Diseases, 170 Morton St., Jamaica Plain, MA 02130 ().

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