CD8+ T cells and Risk for Bacterial Pneumonia and All-Cause Mortality Among HIV-Infected Women

Abstract

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.