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Letters: CD4+ Lymphocytopenia in Systemic Lupus Erythematosus
- Jeffrey Laurence, MD
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
Cytotoxic antilymphocyte antibodies, particularly those restricted to the CD4+ subpopulation of T lymphocytes, may be a factor in idiopathic T-cell depletion, as I briefly noted [1]. They also arise in HIV infection [2], although the lack of a consistent relation between antilymphocyte antibodies titer and the extent of CD4+ or CD8 (+) T-cell depletion or both [3] mitigates their clinical relevance. Disorders with an autoimmune component, such as systemic lupus erythematosus, similarly manifest antilymphocytic antibody [4]. Lymphocytopenia occurs in less than 80% of patients with systemic lupus erythematosus during the acute clinical phase and is often accompanied by profound decreases in total T lymphocytes and particularly the CD4+/CD45RA+ subset (as in the patient described by Drs. Guma and Krakauer). However, direct associations between antilymphocyte antibodies titer and magnitude of cell loss are tenuous. In contrast to their patient, the CD4:CD8 ratio is usually within normal limits [4]. One must also acknowledge that spuriously low CD4 counts may be found in systemic lupus erythematosus and may be linked to deficiency of a CD4 epitope that reacts with a reagent used in its detection, the anti-OKT4A monoclonal antibody [5]. This may reflect the racial background and HLA (human leukocyte antigen) type in which this disease commonly occurs in the United States.
It is reasonable to screen for antilymphocyte antibodies and autoimmune disorders in persons with progressive idiopathic CD4+ T lymphocytopenia. However, given the prolonged period of HIV seronegativity in a few persons infected with HIV, it is also important to evaluate patients with persistent, marked CD4+ T-cell depletion and inverted CD4:CD8 ratio by direct assays for HIV, including viral culture and HIV-1 and -2 proviral amplification.
Jeffrey Laurence, MD
Laboratory for AIDS Virus Research; Cornell University Medical College; New York, NY 10021
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
