Past
research indicates that among HIV negative individuals, liver
cirrhosis can have an impact on immune function. The effects of liver disease
on immunity in HIV-HCV and
HIV-HBV coinfected patients have been
less extensively studied, but it is known that coinfected people tend to develop
more rapid liver
disease progression, especially if they have low
CD4 cell counts.
The
present study, reported in the February 1, 2007 issue of Clinical Infectious
Diseases, showed that cirrhosis was associated with low CD4 cell counts, but
not decreased CD4 cell percentages, a finding that has implications for monitoring
of HIV disease progression in
coinfected individuals.
The
study included 60 HIV negative outpatients with cirrhosis enrolled during 2001-2003
in a prospective, cross-sectional study of the association between liver disease
and CD4 cell counts and percentages. About half (31 patients) had cirrhosis associated
with chronic hepatitis C, and 1 had chronic
hepatitis B.
Results
•
A total of 39 patients
(65%) had low CD4 counts (defined as below 550 cells/mm3) including:
•
26 (43%) with counts
below 350 cells/mm3; o 4 (7%) with counts below 200 cells/mm3.
•
Abnormally low CD4
cell counts were associated with splenomegaly (P = 0.03), thrombocytopenia (P
= 0.002), and leukopenia (P < 0.001).
•
Low CD4 cell counts
were also associated with clinical markers of portal hypertension.
•
95% of patients with
low absolute CD4 cell counts had normal CD4 cell percentages.
•
Mean CD4 cell counts
were significantly lower among patients with cirrhosis than among 7638 HIV negative
historic controls without liver disease (294 vs 925 cells/mm3, respectively).
Conclusion
"Cirrhosis
is associated with low CD4+ T-cell counts in the absence of HIV infection,"
the authors concluded. "Discordance between low absolute CD4+ T-cell counts
and normal CD4+ T cell percentages may be attributable to portal hypertension
and splenic sequestration [of blood cells]."
They
added that, "Our findings have significant implications for the use and interpretation
of absolute CD4+ T-cell counts in HIV-infected patients with advanced liver disease."
In
addition to being the most commonly monitored measure of immune status in HIV
positive individuals, absolute CD4 count is also used by some centers to assess
whether patients with HIV are eligible for liver
transplants.
In
an accompanying editorial, Rajesh T. Gandhi wrote that the study made "a
convincing case," and recommended that assessment of CD4 cell percentage
and degree of liver fibrosis
"may better reveal the relationship between HIV-induced immunosuppression
and liver disease."
Tufts-New
England Medical Center, Boston, MA.
01/30/07
References
B
H McGovern, Y Golan, M Lopez, and others. The Impact of Cirrhosis on CD4+ T Cell
Counts in HIV-Seronegative Patients. Clinical Infectious Diseases 44(3):
431-437. February 1, 2007.
R
T Gandhi. Cirrhosis Is Associated with Low CD4+ T Cell Counts: Implications for
HIV-Infected Patients with Liver Disease. Clinical Infectious Diseases
44(3): 438-440. February 1, 2007.
