PWH suffer from persistent immune dysregulation and chronic inflammation,14 factors that could further intensify liver fibrosis progression and HCC development among PWH with chronic HBV or HCV infection.52 Although lower CD4 cell count could be a reflection of lymphopenia associated with advanced liver diseases resulting from chronic hepatitis (eg, portal hypertension and cirrhosis) instead of immune dysfunction,53 our findings suggest that the association was independent of viral hepatitis coinfection. This evidence concerns the gene CD4 and immune system disorder.