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.