title: CD8 T-Cell Expansion and Inflammation Linked to CMV Coinfection in ART-treated HIV Infection.
abstract: 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.
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Freeman
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Mudd
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center, Veterans Administration Medical Center, Cleveland, Ohio.
authors.forename: Carey L
authors.initials: CL
authors.lastname: Shive
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Souheil-Antoine
authors.initials: SA
authors.lastname: Younes
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Soumya
authors.initials: S
authors.lastname: Panigrahi
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Sieg
authors.affiliation: Department of Medicine, University of California San Francisco.
authors.forename: Sulggi A
authors.initials: SA
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of California San Francisco.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Ohio.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Calabrese
authors.affiliation: Division of Infectious Diseases, University of California San Diego, La Jolla.
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University/University Hospitals Case Medical Center.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Lederman
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D015331:Cohort Studies; D060085:Coinfection / Q000473:pathology*; D016207:Cytokines / Q000097:blood; D003586:Cytomegalovirus Infections / Q000473:pathology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D018655:Lymphocyte Count; D008218:Lymphocytosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry
chemical_list: D044966:Anti-Retroviral Agents; D016207:Cytokines
keywords: CD8 T-cell expansion; CMV; HIV; coinfection; inflammation