Etiology, Pathogenesis, and Natural History of Idiopathic CD4+ Lymphocytopenia

NCT00867269 | Recruiting

• 2 other identifiers: 09010209-I-0102
• Study Type: observational
• Target: 950
• Locations: 1 country
• Sites: 1

Brief Summary

Background:

• Idiopathic CD4+ lymphocytopenia (ICL) is a condition in which there is a decreased level of CD4+ lymphocytes (a type of white blood cell), which can lead to opportunistic infections or autoimmune disorders and diseases. Objectives:
• To characterize the natural history with regard to CD4+ T cell count and onset of infection, malignancy, and autoimmunity.
• To describe the immunological status of patients affected by ICL while providing the best possible standard therapy to eradicate opportunistic infections.
• To establish the timeline of CD4 lymphocytopenia, with particular focus on defining subgroups of patients according to the decline, stabilization, or rise of CD4+ T cell counts over time.
• To characterize the opportunistic infections that occur in ICL patients at microbiologic and molecular levels.
• To characterize the immunophenotype and possible genetic immunodeficiency causes of ICL.
• To determine whether measurable immunologic parameters correlate with the development of opportunistic infections or other comorbidities such as lymphoma in patients with ICL.
• To determine whether there is any association between ICL and autoimmunity.
• To determine CD4+ T cell turnover, survival, functionality, and cytokine responsiveness in ICL patients. Eligibility:
• Patients 2 years of age and older with an absolute CD4 count less than 300 in children 6 years or older and adults or less than 20% of T cells in children younger than 6 on two occasions at least 6 weeks apart.
• Patients with negative results of HIV testing by ELISA, Western Blot, and viral load.
• Patients must not have underlying immunodeficiency conditions, be receiving cytotoxic chemotherapy (anti-cancer drugs that kill cells), or have cancer. Design:
• At the initial visit to the National Institutes of Health, the following evaluations will be conducted:
• Personal and family medical histories.
• Physical examination, including rheumatology evaluation and other consultations as medically indicated (e.g., dermatology, pulmonology, ophthalmology, imaging studies).
• Blood samples for analysis of red and white blood cell counts, liver function, immune hormones, and antibody and autoantibody levels, white blood cell growth and function, and DNA.
• Urinalysis and urine pregnancy testing for female patients of childbearing age.
• Evaluation and treatment of active infections as medically indicated, including biopsies, buccal swabs, pulmonary function tests, and imaging studies.
• Follow-up visits will take place approximately every 12 months or more frequently if indicated, and will continue for a minimum of 4 years and a maximum of 10 years.
• Evaluations at follow-up will include blood samples (i.e., CBC with differential, biochemical profile, HIV testing, etc.) and urinalysis and rheumatology consults.

Conditions

Warts; Idiopathic CD4+ Lymphocytopenia; Cryptococcal Meningitis

Keywords

Opportunistic Infection; Immunodeficiency Syndrome; Autoimmune Disease; CD4+ Lymphocytes; Natural History; Idiopathic CD4 Lymphocytopenia

Outcome Measures

Primary Outcomes (1)

• CD4 <300/microliters or < 20% of total T cells and their blood

  To further characterize the natural history of ICL while also investigating the genetic, environmental, and immunologic features of the condition.

  Baseline and annually

Secondary Outcomes (5)

• Determine CD4+ T cell turnover, survival, functionality and cytokineresponsiveness in selected ICL patients.

  Baseline and annually

• Investigate ICL immune cell homeostasis and trafficking by immunologic studies including tissue biopsies and the utilization of ahumanized mouse model.

  Baseline and annually

• Establish the prognosis of CD4 lymphocytopenia, with particular focus on defining subgroups of patients according to the decline, stabilization, or rise of CD4+T cell counts over time.

  Baseline and annually

• Determine whether measurable immunologic parameters correlate with the development of opportunistic infections or other co-morbidities

  Baseline and annually

• Determine the relationship between ICL and the microbiome.

  Baseline and annually

Study Arms (3)

Blood Relatives

Blood Relatives of ICL subjects

Household Contacts

Household contacts of ICL subjects

ICL Subjects

Patients with confirmed idiopathic CD4 lymphocytopenia

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adults with idiopathic CD4+ lymphocytopenia (ICL) who have CD4 \<300/microliters or \< 20% of total T cells and their blood relatives and household contacts.

You may qualify if:

• Age greater than or equal to 18 years
• Absolute CD4 count \< 300 cells/microL or \< 20% of total T cells on at least two occasions at least 6 weeks apart
• Ongoing care by a referring primary care physician
• Willingness to allow storage of blood and tissue samples for future analysis

You may not qualify if:

• Patients will be ineligible for this study if they satisfy any of the following criteria:
• Known infection with HIV-1, HIV-2, or human T-cell lymphotropic viruses (HTLV-1 or HTLV-2) as demonstrated by enzyme-linked immunosorbent assay (ELISA) and western blot and/or viral load testing
• Known underlying immunodeficiency syndrome other than ICL
• Evidence of active malignancy
• Receipt of medications, herbal substances, or biologic agents known to diminish the CD4+ count within 30 days of when the CD4+ lymphocytopenia was detected
• Any condition that in the judgment of the investigators would place the subject at undue risk or compromise the results of the study.
• To be eligible for study participation as a blood relative, subjects must be greater than or equal to 18 years of age and be a blood relative of an individual who meets or has met the CDC criteria for ICL.
• To be eligible for study participation as a household contact, subjects must be greater than or equal to18 years of age and live within the same household as an ICL subjects participating in this protocol. Blood relatives who are household contacts are eligible to participate.

Sponsors & Collaborators

• National Institute of Allergy and Infectious Diseases (NIAID): lead

Study Sites (1)

National Institutes of Health Clinical Center

Bethesda, Maryland, 20892, United States

RECRUITING

Related Publications (6)

• Fauci AS. CD4+ T-lymphocytopenia without HIV infection--no lights, no camera, just facts. N Engl J Med. 1993 Feb 11;328(6):429-31. doi: 10.1056/NEJM199302113280610. No abstract available.

  PMID: 8093637 BACKGROUND

• Laurence J, Siegal FP, Schattner E, Gelman IH, Morse S. Acquired immunodeficiency without evidence of infection with human immunodeficiency virus types 1 and 2. Lancet. 1992 Aug 1;340(8814):273-4. doi: 10.1016/0140-6736(92)92359-n.

  PMID: 1353194 BACKGROUND

• Ho DD, Cao Y, Zhu T, Farthing C, Wang N, Gu G, Schooley RT, Daar ES. Idiopathic CD4+ T-lymphocytopenia--immunodeficiency without evidence of HIV infection. N Engl J Med. 1993 Feb 11;328(6):380-5. doi: 10.1056/NEJM199302113280602.

  PMID: 8093634 BACKGROUND

• Lisco A, Ortega-Villa AM, Mystakelis H, Anderson MV, Mateja A, Laidlaw E, Manion M, Roby G, Higgins J, Kuriakose S, Walkiewicz MA, Similuk M, Leiding JW, Freeman AF, Sheikh V, Sereti I. Reappraisal of Idiopathic CD4 Lymphocytopenia at 30 Years. N Engl J Med. 2023 May 4;388(18):1680-1691. doi: 10.1056/NEJMoa2202348.

  PMID: 37133586 DERIVED

• Sortino O, Dias J, Anderson M, Laidlaw E, Leeansyah E, Lisco A, Sheikh V, Sandberg JK, Sereti I. Preserved Mucosal-Associated Invariant T-Cell Numbers and Function in Idiopathic CD4 Lymphocytopenia. J Infect Dis. 2021 Aug 16;224(4):715-725. doi: 10.1093/infdis/jiaa782.

  PMID: 34398238 DERIVED

• Perez-Diez A, Wong CS, Liu X, Mystakelis H, Song J, Lu Y, Sheikh V, Bourgeois JS, Lisco A, Laidlaw E, Cudrici C, Zhu C, Li QZ, Freeman AF, Williamson PR, Anderson M, Roby G, Tsang JS, Siegel R, Sereti I. Prevalence and pathogenicity of autoantibodies in patients with idiopathic CD4 lymphopenia. J Clin Invest. 2020 Oct 1;130(10):5326-5337. doi: 10.1172/JCI136254.

  PMID: 32634122 DERIVED

Related Links

• NIH Clinical Center Detailed Web Page

MeSH Terms

Conditions

T-Lymphocytopenia, Idiopathic CD4-Positive; Meningitis, Cryptococcal; Warts; Opportunistic Infections; Immunologic Deficiency Syndromes; Autoimmune Diseases

Condition Hierarchy (Ancestors)

Lymphopenia; Leukopenia; Cytopenia; Hematologic Diseases; Hemic and Lymphatic Diseases; Leukocyte Disorders; Immune System Diseases; Meningitis, Fungal; Central Nervous System Fungal Infections; Mycoses; Bacterial Infections and Mycoses; Infections; Cryptococcosis; Central Nervous System Infections; Central Nervous System Diseases; Nervous System Diseases; Meningitis; Neuroinflammatory Diseases; Papillomavirus Infections; DNA Virus Infections; Virus Diseases; Skin Diseases, Viral; Tumor Virus Infections; Skin Diseases, Infectious; Skin Diseases; Skin and Connective Tissue Diseases

Study Officials

• Irini Sereti, M.D.

  National Institute of Allergy and Infectious Diseases (NIAID)

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Irini Sereti, M.D.

CONTACT

(301) 496-5533; isereti@niaid.nih.gov

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: NIH
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 20, 2009
• First Posted: March 23, 2009
• Study Start: July 13, 2009
• Last Updated: April 29, 2026

Record last verified: 2026-01-08

Locations

US (1)