Do Hepatitis B (Hep B) or Human Immunodeficiency Virus (HIV) cause leukocytosis?

Hepatitis B and HIV Do Not Typically Cause Leukocytosis

Neither Hepatitis B nor HIV infection typically causes leukocytosis; in fact, both infections are more commonly associated with leukopenia or normal white blood cell counts.

Hematological Manifestations in Hepatitis B

Hepatitis B infection is not characterized by leukocytosis. According to available evidence:

• Hematological abnormalities in HBV infection more commonly include:

  • Thrombocytopenia (19.3% of cases)
  • Anemia (12.6% of cases)
  • Leukopenia (7.4% of cases) 1

• Leukocytosis is relatively uncommon in HBV infection, occurring in only about 10.8% of cases, and when present, is typically associated with more severe hepatocellular damage rather than being a direct effect of the virus 1

• The American Association for the Study of Liver Diseases does not list leukocytosis as a typical finding in HBV infection 2, 3

• Chronic HBV infection is characterized by various phases with different immunological profiles, but none specifically associated with elevated white blood cell counts 2

Hematological Manifestations in HIV

HIV infection is also not typically associated with leukocytosis:

• HIV infection is more commonly associated with cytopenias, including leukopenia, rather than elevated white blood cell counts 2

• In HIV-HBV coinfection, hematological abnormalities such as anemia are common, with mean hematocrit values in HIV-infected patients with ESRD being significantly lower (22%) compared to non-HIV infected patients (26%) 2

• The primary hematological manifestation in HIV is anemia, described as "the most common hematological abnormality in HIV-infected patients" 2

Coinfection Considerations

When HBV and HIV coinfection occurs:

• Coinfection leads to higher HBV DNA levels, lower rates of spontaneous HBeAg seroconversion, and more severe liver disease 2

• Liver-related mortality in HIV-HBV coinfected patients is as much as 14-fold higher than in patients with either virus alone 2

• Hematological complications focus on anemia rather than leukocytosis 2

When Leukocytosis Might Occur

While not directly caused by HBV or HIV, leukocytosis may be observed in these patients due to:

1. Secondary bacterial infections
2. Severe hepatocellular damage
3. Medication side effects
4. Other comorbidities

Clinical Implications

For patients with HBV or HIV presenting with leukocytosis:

• Consider alternative causes such as bacterial infection
• Evaluate for liver damage severity, as more severe hepatocellular damage correlates with higher likelihood of hematological abnormalities 1
• Review medication list for drugs that might cause leukocytosis
• Consider other comorbidities that could explain the elevated white blood cell count

In summary, when encountering leukocytosis in a patient with HBV or HIV, clinicians should look beyond these viral infections as the primary cause and investigate other potential etiologies.