CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection

• Published in: Clinical infectious diseases Vol. 62; no. 3; pp. 392 - 396
• Main Authors: Freeman, Michael L., Mudd, Joseph C., Shive, Carey L., Younes, Souheil-Antoine, Panigrahi, Soumya, Sieg, Scott F., Lee, Sulggi A., Hunt, Peter W., Calabrese, Leonard H., Gianella, Sara, Rodriguez, Benigno, Lederman, Michael M.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.02.2016
• Series: Editor's choice
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; CD4-CD8 Ratio; CD4-Positive T-Lymphocytes - immunology; CD8-Positive T-Lymphocytes - immunology; Cohort Studies; Coinfection - pathology; Cytokines - blood; Cytomegalovirus; Cytomegalovirus Infections - pathology; Enzyme-Linked Immunosorbent Assay; Female; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - pathology; HIV/AIDS; Human immunodeficiency virus; Humans; Inflammation; Lymphocyte Count; Lymphocytosis - pathology; Male; Middle Aged; Plasma - chemistry; T cell receptors; CD8 T-cell expansion; HIV; inflammation; CMV; coinfection
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/civ840

Background. Persistent CD8 T-cell expansion, low CD4/CD8 T-cell ratios, and heightened inflammation persist in antiretroviral therapy (ART)-treated human immunodeficiency virus (HIV) infection and are associated with increased risk of morbid outcomes. We explored the role of cytomegalovirus (CMV) infection in CD8 lymphocytosis and inflammation in ART-treated HIV infection. Methods. Absolute CD4 and CD8 T-cell counts were abstracted from clinical records and compared among 32 HIV-infected CMV-seronegative subjects, 126 age, CD4 and gender-matched HIV-infected CMV-seropositive subjects, and among 21 HIV-uninfected controls (9 CMV-negative, 12 CMV-positive). Plasma inflammatory indices were measured in a subset by ELISA. Results. Median CD8 counts/μL were higher in HIV-positive/CMV-positive patients (795) than in HIV-positive/CMV-negative subjects (522, P = .006) or in healthy controls (451, P = .0007), whereas CD8 T-cell counts were similar to controls' levels in HIV-positive/CMV-negative subjects. Higher plasma levels of IP-10 (P = .0011), TNF-RII (P = .0002), and D-dimer (P = .0444) were also found in coinfected patients than in HIV-positive/CMV-negative subjects. Conclusions. CMV infection is associated with higher CD8 T-cell counts, resultant lower CD4/CD8 ratios, and increased systemic inflammation in ART-treated HIV infection. CMV infection may contribute to risk for morbid outcomes in treated HIV infection.