CD8 + T cells and risk for bacterial pneumonia and all-cause mortality among HIV-infected women

Shruti K. Gohil, Moonseong Heo, Ellie Schoenbaum, David Celentano, Liise-anne Pirofski

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Bacterial pneumonia risk is disproportionately high among those infected with HIV. This risk is present across all CD4 + T-cell levels (TCLs), suggesting that additional factors govern susceptibility. This study examines CD8 + TCLs and risk for HIV-associated bacterial pneumonia and all-cause mortality. Methods: Demographic, clinical, and laboratory data were obtained for 885 HIV-infected women enrolled in the HIV Epidemiologic Research Study (HERS). Bacterial pneumonia cases were identified using clinical, microbiological, and radiographic criteria. CD8 + TCLs were assessed at 6-month intervals. Statistical methods included Cox proportional hazards regression modeling and covariateadjusted survival estimates. Results: Relative to a referent CD8 + TCL of 401-800 cells per cubic millimeter, risk for bacterial pneumonia was significantly higher when CD8 + TCLs were <400 (hazard ratio 1.65, P = 0.017, 95% confidence interval 1.10 to 2.49), after adjusting for age, CD4 + TCL, viral load, and antiretroviral use. There was also a significantly higher risk of death when CD8 + TCLs were ≤400 cells per cubic millimeter (hazard ratio 1.45, P = 0.04, 95% confidence interval 1.02 to 2.06). Covariate-adjusted survival estimates revealed shorter time to pneumonia and death in this CD8 + TCL category, and the overall associations of the categorized CD8 + TCL with bacterial pneumonia and all-cause mortality were each statistically significant (P = 0.017 and P < 0.0001, respectively). Conclusions: CD8 + TCL ≤400 cells per cubic millimeter was associated with increased risk for pneumonia and all-cause mortality in HIV-infected women in the HERS cohort, suggesting that CD8 + TCL could serve as an adjunctive biomarker of pneumonia risk and mortality in HIV-infected individuals.

Original languageEnglish (US)
Pages (from-to)191-198
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume60
Issue number2
DOIs
StatePublished - Jun 1 2012

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Bacterial Pneumonia
HIV
T-Lymphocytes
Mortality
Pneumonia
Epidemiologic Studies
Confidence Intervals
Survival
Viral Load
Research
Biomarkers
Demography

Keywords

  • CD8 T cell
  • HIV
  • Mortality
  • Pneumonia

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

CD8 + T cells and risk for bacterial pneumonia and all-cause mortality among HIV-infected women. / Gohil, Shruti K.; Heo, Moonseong; Schoenbaum, Ellie; Celentano, David; Pirofski, Liise-anne.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 60, No. 2, 01.06.2012, p. 191-198.

Research output: Contribution to journalArticle

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abstract = "Background: Bacterial pneumonia risk is disproportionately high among those infected with HIV. This risk is present across all CD4 + T-cell levels (TCLs), suggesting that additional factors govern susceptibility. This study examines CD8 + TCLs and risk for HIV-associated bacterial pneumonia and all-cause mortality. Methods: Demographic, clinical, and laboratory data were obtained for 885 HIV-infected women enrolled in the HIV Epidemiologic Research Study (HERS). Bacterial pneumonia cases were identified using clinical, microbiological, and radiographic criteria. CD8 + TCLs were assessed at 6-month intervals. Statistical methods included Cox proportional hazards regression modeling and covariateadjusted survival estimates. Results: Relative to a referent CD8 + TCL of 401-800 cells per cubic millimeter, risk for bacterial pneumonia was significantly higher when CD8 + TCLs were <400 (hazard ratio 1.65, P = 0.017, 95{\%} confidence interval 1.10 to 2.49), after adjusting for age, CD4 + TCL, viral load, and antiretroviral use. There was also a significantly higher risk of death when CD8 + TCLs were ≤400 cells per cubic millimeter (hazard ratio 1.45, P = 0.04, 95{\%} confidence interval 1.02 to 2.06). Covariate-adjusted survival estimates revealed shorter time to pneumonia and death in this CD8 + TCL category, and the overall associations of the categorized CD8 + TCL with bacterial pneumonia and all-cause mortality were each statistically significant (P = 0.017 and P < 0.0001, respectively). Conclusions: CD8 + TCL ≤400 cells per cubic millimeter was associated with increased risk for pneumonia and all-cause mortality in HIV-infected women in the HERS cohort, suggesting that CD8 + TCL could serve as an adjunctive biomarker of pneumonia risk and mortality in HIV-infected individuals.",
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