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

• Authors: Matthew Triplette, University of Washington; Engi F. Attia, University of Washington; Kathleen M. Akgün, VA Medical Center; Guy W. Soo Hoo, VA Medical Center; Matthew S. Freiberg, Vanderbilt University; Adeel A. Butt, Weill Cornell Medical College; Cherry Wongtrakool, Emory University; Matthew Bidwell Goetz, VA Medical Center; Sheldon T. Brown, VA Medical Center; Christopher J. Graber, VA Medical Center; Laurence Huang, University of California San Francisco; Kristina Crothers, University of Washington
• Journal Title: PLoS ONE
• Volume: Volume 12, Number 1
• Publisher: Public Library of Science | 2017-01-01, Pages e0170857-e0170857
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0170857
• Subjects: Health Sciences, Immunology; Health Sciences, General
• Keywords: HIV; CD4/CD8 T-cell ratio; COPD; chronic lung disease; tobacco

Abstract

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.