CD4+ T cell discordance in HIV-infected patients with and without hepatitis C virus (HCV)-coinfection
| Autor: | Jung, Dorothy Eunhyun |
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| Rok vydání: | 2012 |
| Druh dokumentu: | Thesis/Dissertation |
| Popis: | Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. HIV infected patients with hepatitis C virus (HCV) infection are at increased risk of faster fibrosis progression and end-stage liver disease compared to patients with HCV alone. Why HIV /HCV -coinfected patients progress more rapidly to advanced liver disease is unknown, though several studies suggest that HIV -related immunosuppression may play a role. We have recently shown that low absolute CD4+ counts are also prevalent in patients with liver cirrhosis who are HIV seronegative. Furthermore, HIV seronegative cirrhotic patients with low absolute CD4+ counts have normal CD4+ percentages. This CD4+ "discordance" among patients with liver disease points towards an alternate mechanism for low CD4 T cell counts, other than HIV-induced immunosuppression. In this retrospective study, we compared the prevalence of CD4 Tcell discordance in HIV/HCV-coinfected patients and patients with HIV alone. We also examined clinical and laboratory exam findings associated with this discordant profile. We show that discordance between absolute CD4 counts and CD4 T -cell percentages was significantly associated with HIV/HCV-coinfection as well as leucopenia. We also found that a physical exam finding of hepatomegaly, splenomegaly, and/or spider angiomata as well as certain laboratory markers of advanced liver disease (eg, AST/ALT > 1) may be associated with CD4 T-cell discordance. We conclude that among patients co infected with HIV and HCV, CD4+ discordance may be an important screening tool in patients with possible underlying liver disease. Low CD4+ counts in these patients may correlate not only with advanced HIV immunosuppression, but may indicate underlying liver disease when accompanied by a normal CD4+ percentage. 2999-01-01 |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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