CD4 and intrahepatic cholangiocarcinoma: This has been reported in a related study in Botswana in southern Africa that showed comparable findings of women with HIV being diagnosed with ICC at a much younger age compared to women without HIV, and the hazards of early mortality were significantly higher in women with HIV.(28) The effects of HIV on earlier ICC mortality are not clearly understood, but may be related to immune suppression with lower CD4 count.(28, 29) Further research in this population should explore this possibility.