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. 2017 Jan 25;12(1):e0170857.
doi: 10.1371/journal.pone.0170857. eCollection 2017.

A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

Matthew Triplette  1 , Engi F Attia  1 , Kathleen M Akgün  2   3 , Guy W Soo Hoo  4   5 , Matthew S Freiberg  6 , Adeel A Butt  7   8 , Cherry Wongtrakool  9   10 , Matthew Bidwell Goetz  4   5 , Sheldon T Brown  11   12 , Christopher J Graber  4   5 , Laurence Huang  13 , Kristina Crothers  1
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A Low Peripheral Blood CD4/CD8 Ratio Is Associated with Pulmonary Emphysema in HIV

Matthew Triplette et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Severity of emphysema by CD4/CD8 ratio group (p = 0.02 for trend)*.
* Cuzick’s test of trend **Emphysema categories of 26–50%, 51–75% and >75% collapsed for this graph given low numbers of subjects in higher emphysema categories.
See this image and copyright information in PMC

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