Correspondence

CD4+ Counts in Seronegative Homosexual Men

N Engl J Med 1993; 328:442February 11, 1993

Article

To the Editor:

The Multicenter AIDS Cohort Study is an ongoing study of gay and bisexual men seen every six months since 19841. To assess the prevalence of idiopathic CD4+ T-lymphocytopenia2,3 in this population, we studied 2713 men who were seronegative for human immunodeficiency virus (HIV) type 1 who had at least one assessment of CD4+ cells. In 2285 of these men the number of CD4+ cells and the number of CD4+ cells as a percentage of total T lymphocytes have been measured on at least four visits since 1985; the men were HIV-seronegative at each visit. The flow-cytometry quality-control program suggested that data obtained during visits 1 and 2 had relatively high interlaboratory variability,4 so data for this analysis only include visits 3 through 15 (1985 to 1991). Of the 22,643 measurements of CD4+ cells performed in the 2713 seronegative men, 99.7 percent yielded values of more than 300 cells per cubic millimeter, suggesting that variations from normal, together with measurement errors, resulted in a value of less than 300 cells per cubic millimeter in 0.3 percent of all counts. Among the 2285 men, 24 had CD4+ cell counts below 300 cells per cubic millimeter or a measurement in which CD4+ cells made up less than 20 percent of total lymphocytes (or both) on at least two occasions. Of these 24 men, only 1 had a low CD4+ cell count or a low percentage of CD4+ cells that was not transient, suggesting a chronic immunosuppressive condition. The low CD4+ cell counts were easily explained, however, since this man had gastrointestinal cancer treated with immunosuppressive medications and radiation therapy; thus, the provisional case definition of idiopathic CD4+ T-lymphocytopenia outlined by the Centers for Disease Control and Prevention was not met. Studies of HIV in other large cohorts have similarly failed to find cases of persistent idiopathic CD4+ T-lymphocytopenia (Smith et al.3 and Aledort et al.5 in this issue, and Sheppard H: personal communication). Thus, persistently low CD4+ cell counts without HIV infection, cancer chemotherapy, or other known causes of immunosuppression have not been seen during 11,321.5 person-years of study in the Multicenter AIDS Cohort Study.

Sten H. Vermund, M.D., Ph.D.
National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892

Donald R. Hoover, Ph.D.
Kan Chen, M.S.
Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205

for the Multicenter AIDS Cohort Study

5 References

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   Full Text | Web of Science | Medline

Citing Articles (7)

Citing Articles

1. 1

   A. Patel, J. Patel, J. Ikwuagwu. (2010) Treatment of progressive multifocal leukoencephalopathy and idiopathic CD4+ lymphocytopenia. Journal of Antimicrobial Chemotherapy 65:12, 2489-2492
   CrossRef

2. 2

   Pride Chigwedere, M. Essex. (2010) AIDS Denialism and Public Health Practice. AIDS and Behavior 14:2, 237-247
   CrossRef

3. 3

   Paula J. Busse, Charlotte Cunningham-Rundles. (2002) Primary leptomeningeal lymphoma in a patient with concomitant CD4+ lymphocytopenia. Annals of Allergy, Asthma & Immunology 88:3, 339-342
   CrossRef

4. 4

   Dianne Vertes, Michael D. Linden, John L. Carey. (1995) Idiopathic CD4 + T-lymphocytopenia: Analysis of a patient with selective IgA deficiency and no evidence of HIV infection. Cytometry 22:1, 40-44
   CrossRef

5. 5

   (1993) CD4+ T-Lymphocytopenia without HIV Infection. New England Journal of Medicine 328:25, 1847-1850
   Full Text

6. 6

   Fauci, Anthony S., . (1993) CD4+ T-Lymphocytopenia without HIV Infection -- No Lights, No Camera, Just Facts. New England Journal of Medicine 328:6, 429-431
   Full Text

7. 7

   Smith, Dawn K.Neal, Joyce J.Holmberg, Scott D.the Centers for Disease Control Idiopathic CD4+ T-Lymphocytopenia Task Force. (1993) Unexplained Opportunistic Infections and CD4+ T-Lymphocytopenia without HIV Infection -- An Investigation of Cases in the United States. New England Journal of Medicine 328:6, 373-379
   Full Text