Hung Justine, Vonasek Bryan, Rosenberg Daniel, Vo Tri, Striker Rob
Department of Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA.
Department of Biochemistry, University of Wisconsin-Madison, Madison, WI 53706, USA.
Infect Dis Rep. 2024 Dec 16;16(6):1230-1239. doi: 10.3390/idr16060097.
BACKGROUND/OBJECTIVES: Common Variable Immunodeficiency Disease (CVID) and other immunodeficiencies can present in subtle and variable ways. Whether or not a genetic lesion can be identified, there are not well understood biomarkers that quantitatively describe how severe a deficiency is. Here we discuss two possible ranking systems, CD4/CD8 T cell ratios and Immune Health Grades, and how such data maybe applicable to some immunodeficiencies.
This is not a systematic review, but we identify papers relating to immunodeficiencies with enough data to comment on the CD4/CD8 and Immune Health Grade. We also summarized relevant data publicly available from USIDNET, a website that compiles data on immunodeficiencies, and provide two new cases that illustrate ways that this information can alter clinical assessment.
We review the HIV literature on CD4/CD8 T cell data and how this correlates with both immunologic function and comorbidity better than CD4 count alone. The ratio aslso relates to a new system called Immune Health Grades (IHG) derived from young adult to elderly subjects from many NIH cohorts without HIV. CVID is often thought of as an antibody problem, but in fact most patients also have low CD4/CD8 ratio and other cellular abnormalities. We review IDNET to categorize nine molecular immunodeficiencies including two subcategories of CVID into low, normal, or high ratios. Finally, we present two new cases in the literature of patients with recurrent infection and discuss how viewing the cases through the "lens" of CD4/CD8 ratio and IHG can facilitate clinical decisions.
Emerging data suggests at least some immunodeficiencies can be grouped by how abnormal their CD4/CD8 ratio or IHG. This represents a clinically available biomarker that can be tracked to see if the condition is worsening or not.
背景/目的：常见变异型免疫缺陷病（CVID）和其他免疫缺陷可能以微妙且多变的方式表现出来。无论是否能识别出基因病变，目前尚没有充分理解的生物标志物可定量描述缺陷的严重程度。在此，我们讨论两种可能的分级系统，即CD4/CD8 T细胞比值和免疫健康等级，以及此类数据如何可能适用于某些免疫缺陷。
本研究并非系统综述，但我们识别了与免疫缺陷相关且有足够数据可对CD4/CD8和免疫健康等级进行评论的论文。我们还总结了从美国免疫缺陷网络（USIDNET）公开获取的相关数据，该网站汇编了免疫缺陷数据，并提供了两个新病例，以说明这些信息可如何改变临床评估。
我们回顾了关于CD4/CD8 T细胞数据的HIV文献，以及该数据如何比单独的CD4计数更好地与免疫功能和合并症相关联。该比值还与一种名为免疫健康等级（IHG）的新系统相关，该系统源自许多美国国立卫生研究院（NIH）无HIV感染队列中的青年至老年受试者。CVID通常被认为是抗体问题，但实际上大多数患者的CD4/CD8比值也较低且存在其他细胞异常。我们查阅IDNET将九种分子免疫缺陷（包括CVID的两个亚类）分类为低、正常或高比值。最后，我们展示了文献中两例复发性感染患者的新病例，并讨论了通过CD4/CD8比值和IHG的“视角”看待这些病例如何有助于临床决策。
新出现的数据表明，至少某些免疫缺陷可根据其CD4/CD8比值或IHG的异常程度进行分组。这代表了一种可在临床上使用的生物标志物，可对其进行跟踪以观察病情是否恶化。
