Idiopathic CD4+ T‐lymphocytopenia in HIV seronegative men with hemophilia and sex partners of HIV seropositive men

Persons with hemophilia or other HIV‐1 risk factors may be more likely to have idiopathic CD4+ T‐lymphocytopenia (ICL). We determined the frequency of ICL in prospectively followed cohorts of HIV‐1 seronegative hemophilic men and seronegative female sex partners of HIV‐1 infected hemophilic men, and examined factors potentially associated with ICL. Seven of 304 (2.3%) seronegative hemophilic men and one of 160 (0.6%) female partners met the ICL definition, but the condition resolved for two of the men and for the sole female partner. All five men with persistent ICL had lymphocytopenia (<1,200 total lymphocytes/ül) and <300 total CD4+ lymphocytes/ü only one had a low CD4+ percent‐ age. On the most recent measurement, 14.5% of the 304 seronegative hemophilic men had lymphoctopenia. Compared with matched hemophilic controls, men with persistent ICL more often had a history of liver disease (3/5 cases, 0/21 controls, P = 0.007) or splenomegaly (3/5 cases, 4/21 controls; P = 0.04), but not severe hemophilia, greater clotting factor concentrate exposure, high alanine aminotransferase levels, hepatitis B virus antigenemia, or detectable hepatitis C virus RNA in plasma. All five cases and 20/21 controls had antibodies to hepatitis C virus present in their serum. In this cohort of hemophilic men, ICL was related to lymphocytopenia associated with liver disease rather than selective loss of CD4+ lymphocytes.