CD4 and Granuloma: Granuloma formation in S. mansoni infection is a CD4+ dependent process and earlier studies have hypothesized that the destruction of helper CD4+ T-lymphocytes (Th2) by HIV-1, coupled with the significant importance of CD4+ cells in the formation of granuloma, may lead to a decreased ability of the Th2 arm to produce pro-inflammatory cytokines such as TNF-α, IL-6, IL-1, IL-13 which are responsible for stimulating the inflammatory cells responsible for fibrogenesis, and hence lead to severe hepatic morbidity [78,85].