Absolute CD4 cell count may predict disease progression and death in individuals coinfected with HIV and hepatitis C virus (HCV), according to a study published in AIDS Research and Human Retroviruses.1

Coinfection with HCV and HIV is common,2 and liver fibrosis and cirrhosis may cause discordance between the absolute CD4 T lymphocyte count and CD4 T lymphocyte percentage, possibly because of splenic sequestration of lymphocytes.3,4 CD4 T lymphocyte measurements and CD4/CD8 ratios may be used when initiating antiretroviral therapy in HIV-infected patients in low-income countries; therefore, researchers sought to evaluate this CD4 T lymphocyte discordance in 380 HIV/HCV coinfected adults and to study its association with progression to AIDS, liver disease, and death.1

They found that discordance alone was not responsible for any of the outcomes, but that the absolute CD4 T lymphocyte count and CD4 percentage could predict all-cause mortality independently in patients who are coinfected with HIV/HCV.

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These associations persisted despite adjusting for other predictors of survival such as gender, age, HIV exposure, platelet count, hepatitis B surface antigen, and HCV RNA status.

In addition, a higher CD4/CD8 ratio was associated with a lower mortality risk, and only absolute CD4 cell measurements could predict progression to AIDS. Development of liver disease was not associated with either CD4 T lymphocyte count or CD4 percentage.   

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The authors concluded that, “Despite a high prevalence of lymphocyte-subpopulation discordance with HIV/HCV coinfection, absolute CD4 cell count predicted mortality and AIDS, whereas CD4 percentage only predicted mortality.”1

They added, “These findings may be necessary and useful tools in countries where [antiretroviral therapy] is not initiated for all HIV-infected individuals.”


  1. Hansen S, Kronborg G, Benfield T. Prediction of liver disease, AIDS and mortality based on discordant absolute and relative peripheral CD4 T lymphocytes in HIV/HCV co-infected individuals [published online September 11, 2018]. AIDS Res Hum Retroviruses. doi: 10.1089/AID.2017.0058
  2. Operskalski EA, Kovacs A. HIV/HCV co-infection: pathogenesis, clinical complications, treatment, and new therapeutic technologies. Curr HIV/AIDS Rep. 2011;8(1):12-22.
  3. McGovern BH, Golan Y, Lopez M, et al. The impact of cirrhosis on CD4+ T cell counts in HIV-seronegative patients. Clin Infect Dis. 2007;44(3):431-437.
  4. Mandorfer M, Reiberger T, Payer BA, Peck-Radosavljevic M; Vienna HIV & Liver Study Group. The influence of portal pressure on the discordance between absolute CD4+ cell count and CD4+ cell percentage in HIV/hepatitis C virus-coinfected patients. Clin Infect Dis. 2013;56(6):904-905.