About this item:

613 Views | 686 Downloads

Author Notes:

Correspondence : Matthew Triplette mtrip.uw.edu

The authors thank the Veterans who participated in EXHALE and the coordinators who made the study possible.

This material is the result of work supported with the resources and the use of facilities at the Veterans Affairs Connecticut Healthcare System, West Haven, CT; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; the Atlanta Veterans Affairs Medical Center, Decatur, GA; and the James J. Peters Veterans Affairs Medical Center, Bronx, NY.

The views expressed in this article are those of the authors and do not necessary reflect the position or policy of the Department of Veterans Affairs.


Research Funding:

This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) [R01 HL090342 and 5R01HL126536 to Dr. Crothers, T32 HL007287-37 supporting Dr. Triplette under Drs. Robb Glenny and J. Randall Curtis, K24 HL087713 to Dr. Huang] and the National Institute on Alcohol Abuse and Alcoholism at NIH [U01 AA013566].


  • HIV
  • CD4/CD8 T-cell ratio
  • COPD
  • chronic lung disease
  • tobacco

A low peripheral blood CD4/CD8 ratio is associated with pulmonary emphysema in HIV

Show all authors Show less authors


Journal Title:



Volume 12, Number 1


, Pages e0170857-e0170857

Type of Work:

Article | Final Publisher PDF


Objectives: The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and may be a marker of chronic lung disease in this population. Therefore, we sought to determine whether the CD4/CD8 ratio was associated with chronic obstructive pulmonary disease (COPD), particularly the emphysema subtype, in a cohort of HIV+ subjects. Methods: We performed a cross-sectional analysis of 190 HIV+ subjects enrolled in the Examinations of HIV Associated Lung Emphysema (EXHALE) study. Subjects underwent baseline laboratory assessments, pulmonary function testing and chest computed tomography (CT) analyzed for emphysema severity and distribution. We determined the association between CD4/CD8 ratio and emphysema, and the association between CD4/CD8 ratio and pulmonary function markers of COPD. Results: Mild or greater emphysema (>10% lung involvement) was present in 31% of subjects. Low CD4/CD8 ratio was associated with >10% emphysema in multivariable models, adjusting for risk factors including smoking, current and nadir CD4 count and HIV RNA level. Those with CD4/CD8 ratio <0.4 had 6.3 (1.1-39) times the odds of >10% emphysema compared to those with a ratio >1.0 in fully adjusted models. A low CD4/CD8 ratio was also associated with reduced diffusion capacity (DLCO). Conclusions: A low CD4/CD8 ratio was associated with emphysema and low DLCO in HIV+ subjects, independent of other risk factors and clinical markers of HIV. The CD4/CD8 ratio may be a useful, clinically available, marker for risk of emphysema in HIV+ subjects in the antiretroviral therapy (ART) era.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Universal : Public Domain Dedication License (http://creativecommons.org/publicdomain/zero/1.0/).

Creative Commons License

Export to EndNote