Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
J Acquir Immune Defic Syndr. 2012 Jun 1;60(2):191-8. doi: 10.1097/QAI.0b013e31824d90fe.
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.
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 covariate-adjusted survival estimates.
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).
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.
感染 HIV 的人群中，细菌性肺炎的风险高得不成比例。这种风险存在于所有 CD4(+) T 细胞水平（TCLs），这表明还有其他因素决定了易感性。本研究检查了 CD8(+) TCLs 与 HIV 相关细菌性肺炎和全因死亡率的关系。
对参加 HIV 流行病学研究（HERS）的 885 名 HIV 感染女性的人口统计学、临床和实验室数据进行了收集。使用临床、微生物学和影像学标准确定细菌性肺炎病例。每 6 个月评估一次 CD8(+) TCL。统计方法包括 Cox 比例风险回归模型和协变量调整后的生存估计。
与 CD8(+) TCL 为 401-800 个细胞/立方毫米的参照值相比，当 CD8(+) TCL <400 时，发生细菌性肺炎的风险显著增加（风险比 1.65，P = 0.017，95%置信区间 1.10 至 2.49），调整年龄、CD4(+) TCL、病毒载量和抗逆转录病毒药物使用后。当 CD8(+) TCL 为 ≤400 个细胞/立方毫米时，死亡风险也显著增加（风险比 1.45，P = 0.04，95%置信区间 1.02 至 2.06）。调整后的协变量生存估计显示，在这个 CD8(+) TCL 类别中，肺炎和死亡的时间更短，并且分类后的 CD8(+) TCL 与细菌性肺炎和全因死亡率的总体关联均具有统计学意义（P = 0.017 和 P < 0.0001）。
在 HERS 队列中，HIV 感染女性的 CD8(+) TCL ≤400 个细胞/立方毫米与肺炎和全因死亡率风险增加相关，表明 CD8(+) TCL 可能作为 HIV 感染者肺炎风险和死亡率的辅助生物标志物。
