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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 90-94

Review on role of CD4 T-cells in patients with respiratory illness and human immunodeficiency virus infection


1 Department of Physiology, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Oral Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission17-Jan-2020
Date of Acceptance12-Feb-2020
Date of Web Publication17-Jun-2020

Correspondence Address:
Dr. Sandeep Bhattacharya
Department of Physiology, King George's Medical University, Lucknow - 226 010, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_5_20

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  Abstract 


Human immunodeficiency virus (HIV) infection is now considered as a chronic disease in a population having a higher prevalence of several commodities. Infection with HIV has now emerged as the strongest risk factor for the development of active tuberculosis, asthma, chronic obstructive pulmonary disorder, and lung cancer. Several studies have investigated the presence of respiratory symptoms in the HIV-infected population. HIV infects CD4+ T-lymphocytes selectively and causes the destruction of CD4+ T-cells directly as well as indirectly, which leads to gradual loss of the CD4+ T-cell numbers in peripheral circulation. In immune response, CD4+ T-lymphocytes play a central regulatory role. The decrease in numbers of CD4+ T-cell can compromise the normal immune functions of the body. CD4+ T-cell numbers in circulation can provide important information about the immune competence of an individual since early detection and appropriate management of the disease is a priority, in order to improve patients' prognosis and to improve the quality of life.

Keywords: Asthma, CD4+ T-cell, chronic obstructive pulmonary disorder, comorbidities, human immunodeficiency virus, lung cancer


How to cite this article:
Gaur P, Bhattacharya S, Kant S, Kushwaha R A, Pandey S, Sharma S. Review on role of CD4 T-cells in patients with respiratory illness and human immunodeficiency virus infection. Biomed Biotechnol Res J 2020;4:90-4

How to cite this URL:
Gaur P, Bhattacharya S, Kant S, Kushwaha R A, Pandey S, Sharma S. Review on role of CD4 T-cells in patients with respiratory illness and human immunodeficiency virus infection. Biomed Biotechnol Res J [serial online] 2020 [cited 2020 Jul 13];4:90-4. Available from: http://www.bmbtrj.org/text.asp?2020/4/2/90/286846




  Introduction Top


Lung is a major target organ for human immunodeficiency virus (HIV) infection that has been shown to be present in T- and B-lymphocytes, pulmonary fibroblasts, macrophages, natural killer cells, eosinophils, monocytes, and dendritic cells. It has been shown that there are clear associations between immunosuppression, as indicated by the CD4 cell count and the risk of developing specific pulmonary infections. The CD4 cell surface marker is expressed by natural killer T-cells as well as conventional Class II-restricted CD4+ T-cells, which is a unique subgroup of lymphocytes having the features of both classic T-cells and natural killer cells. In immune response, CD4+ T-lymphocytes play a central regulatory role. The decrease in numbers of CD4+ T-cell can compromise the normal immune functions of the body. The number of CD4+ T-cells in circulation gives an important information about the immune competence of an individual. CD4+ T-cell estimation is an important parameter in immune deficiency disorders. The applications of immunophenotyping of CD4+ T-cells include the diagnosis of immunodeficiency disorders as well as the evaluation of immune-mediated diseases and the assessment of immune reconstitution following stem cell transplantation and also in the monitoring of disease progression of HIV infection. HIV infects CD4+ T-lymphocytes selectively and causes the destruction of CD4+ T-cells directly as well as indirectly, which leads to gradual loss of the CD4+ T-cell numbers in peripheral circulation. Therefore, the CD4+ T-cell counts are being used to monitor the disease progression in HIV infection and to decide the threshold for initiation of antiretroviral therapy as well as to monitor the efficacy of ART and to initiate prophylactic treatment for opportunistic infections.[1],[2] It has been demonstrated that the most frequent respiratory diagnoses in the HIV-infected patients are upper respiratory tract infection, acute bronchitis, and acute sinusitis. It has been shown that they occur at all strata of CD4 cell counts and have higher rates compared with HIV-negative control. Pulmonary tuberculosis (PTB) and recurrent bacterial pneumonia occur more frequently in patients with CD4 cell counts <400 cells/μL, and it has been also found that disseminated tuberculosis (TB) and pneumocystis pneumonia usually diagnose when CD4 cell counts drop below 200 cells/μL. The CD4+ T-cell counts are known to be influenced by race and environmental factors also.[3],[4],[5],[6] Several studies have investigated the presence of respiratory symptoms in the HIV-infected population. The adaptive immune system actively participates in the development and progression of chronic obstructive pulmonary disorder (COPD) by elaboration of cytokines and other mediators by production of injurious autoantibodies. CD8 + lymphocytes may be the predominant cellular element for direct mediation of tissue injuries, but the importance of CD4+ lymphocytes in orchestrating the inflammatory response and facilitating autoimmune humoral responses. In addition to pro-inflammatory effects of CD4+ lymphocytes, a subset of these cells may also influence the progression of immunologic diseases including COPD, by diminishing the intensity of inflammatory cascades. It has been demonstrated that a small proportion of CD4+ T-lymphocytes with distinctive phenotypic characteristics shown to exert the suppressive effects on inflammatory processes common to many immunologic and autoimmune diseases.[7] Anthracosis is a chronic pulmonary disease having black pigmentation of the bronchial mucosa which is caused by carbon accumulation in the lungs, aspiration of coal dust, or frequent contact with the air pollution, and in some cases, it has been associated with PTB. The disease is usually specified by clinical symptoms such as a cough and shortness of breath and without a history of smoking. The outcomes of the previous study suggest that changes in the CD4/C8 levels in serum and bronchoalveolar lavage (BAL) fluid may have a leading role in the diagnosis or prognosis of anthracosis. Due to the strong association of anthracosis and pulmonary TB, TB should be considered in patients with anthracosis, which in turn can help to the early diagnosis and cure of the patients.[8] The detection of cellular compositions, CD markers, such as CD8 and CD4 in serum, and BAL fluid may help to understand the relevant pathophysiological mechanism and functional status of the cells in this disease. The analysis of changes in inflammatory cells and also the CD4/CD8 ratios in the BAL fluid and serum provides valuable diagnostic tools in some unusual pulmonary diseases such as hypersensitivity pneumonitis, sarcoidosis, and eosinophilic pneumonia.[9] The aim of this review was to describe CD4 in patients with HIV infection and respiratory diseases.


  Human Immunodeficiency Virus and Chronic Obstructive Pulmonary Disorder Top


HIV infection is now considered as a chronic disease in a population having higher prevalence of several comorbidities. International guidelines detailed specific recommendations for cardiovascular, hepatic, metabolic, and psychiatric disorders in this population but did not universally contain specific recommendations on chronic respiratory diseases.[10],[11],[12] COPD will become the third most common cause of death in 2030 in the general population. Early detection and appropriate management of the disease is a priority, in order to improve patients' prognosis and to improve the quality of life. It has been observed that eighty-one percent of the patients receive antiretroviral therapy (ART) and HIV viral load is undetectable in 88.5% of cases.[13] From the previous study, it has been found that the CD4 cell count is strongly and independently correlated with COPD. The existence of an independent correlation between CD4 cell count and COPD should suggest clinicians to be aware of COPD risk for patients with less than 200 CD4 cells/mm3 in these patients, particularly if they are smokers. The results from one of the previous studies also suggest that HIV could increase the risk of COPD through CD4 cell count depletion.[14] Another study by Drummond et al. observed that the association with CD4 cell count disappeared after adjustment for HIV viral load and suggested that HIV viral load was more determinant in respiratory decline than CD4 cell level in a cohort of 303 HIV-infected patients.[15] Results from the study confirm a plausible role played by poor control of HIV disease in COPD pathogenesis. However, the study was probably underpowered for testing of the specific role of CD4 cell count because the population was limited to intravenous drug users, heavy tobacco smokers, and several drug users with very poor control of their HIV disease, including a global low level of CD4 cells such as 323/mm3 versus 622 CD4 cells/mm3 in that population and a frequent high HIV viral load.[16] Another study has also recently shown a significant correlation between CD4 cell count defects in BAL fluid in the COPD with HIV-infected patients.[17] The link between CD4 cell count and COPD is also supported by various pathogenetic explanations. CD4 cell defect could favor COPD through bronchial colonization, especially by Pneumocystis jirovecii and secondary bronchial inflammation, dysimmune processes, and accelerated aging.[18],[19],[20] It has been suggested that the risk of comorbid COPD in patients infected with HIV may be underestimated and needs to be part of routine screenings. It has been found that 9% of patients with HIV had COPD. In most of the HIV/COPD cases, it has been reported that patients had never been tested or treated for COPD, and depleted CD4 cells, a marker for HIV, may also serve as a flag for COPD. It has been demonstrated that the existence of an independent correlation between CD4 cell count and COPD should suggest to clinicians to be aware of COPD risk for patients having less than 200 CD4 cells/mm3 in particularly smoking patients. CD4 cell count is strongly and independently correlated with COPD. The existence of an independent correlation between CD4 cell count and COPD should suggest clinicians to be aware of COPD risk for patients with less than 200 CD4 cells/mm3 in these patients, particularly in smokers.


  Human Immunodeficiency Virus and Asthma Top


Asthma is a chronic airway inflammatory disease, characterized by bronchospasm, mucosal edema, airway hyperresponsiveness, and airway secretion increase.[21] The disease brings a huge economic burden on both the patients as well as the society.[22] The mechanism of asthma is complicated and remains largely unknown; therefore, it is of great significance to explore the pathogenesis of asthma. It has been found that activated neutrophils play a crucial role in the development of severe asthma though secretion of several enzymes, inflammatory medium as well as cytokines.[23] A study by Akbari et al. proved that the CD4+ natural killer T-cells play a crucial role in human asthma development[24] as well as CD4+ T-cells can promote the exacerbation of chronic allergic asthma by producing interleukin-17 (IL-17).[24] Helper T-cells (Th2), one of the CD4+ T-cell subgroups, also play an important role in the treatment of severe asthma.[25] In addition, the functions of transcription growth factor-β and IL-5 and IL-8 in remodeling of asthmatic lung tissues have been confirmed.[26],[27],[28] Some previous studies also have been focused on the immune effects on progression of asthma. Inflammatory cells such as T-lymphocytes,[29] mast cells,[30] and macrophages[31] and the inflammatory medium produced by these cells as well as the structural cells such as epithelial cells[32] all participate in the progression of asthma. Several studies have demonstrated the roles of CD4+ T-cells in the development of the inflammatory response in asthma. Asthma is associated with excessive immune reactivity, mediated by T-cells, which leads to inflammation and narrowing of the airway.[33],[34],[35],[36] Several studies showed that low CD4 cell counts, history of smoking and intravenous drug use, and previous history of pneumonia were associated with increased risk of dyspnea and cough symptom. It has been identified that the loss of CD4 T-cells in untreated HIV-infected children is protective against asthma and ART acts as a potential risk factor for asthma due to immune reconstitution of CD4 T-cells. Similar results were seen in an earlier another study of 136 HIV-infected adult participants in a community clinic, showing that a recent CD4 count of ≥200 cells/dL was positively associated with current asthma.[37] The mean CD4 count in participants with asthma was significantly higher than other participants. HIV infection is associated with a decline in CD4+ T-cell numbers, a reduction in the T-cell-mediated immune responses to antigens, and a disruption of intercellular signaling within the immune system. It has been reported that improved cellular immunity and higher CD4 counts may lead to airway hypersensitivity and the development of asthma. The mean CD4 count in participants with asthma was significantly higher than other participants.


  Human Immunodeficiency Virus and Tuberculosis Top


HIV infection is an important infection which is seen worldwide. Patients with HIV infections usually have impaired immune function and get infected by other concurrent infections. TB is a common concurrent infection in HIV-infected patients.[38] CD4+ T helper (Th) subsets play a major role in orchestrating immune responses to Mycobacterium tuberculosis.[39],[40],[41],[42] It has been found that the national HIV prevalence for India indicates that 0.22% of women and 0.36% of men aged 15–49 years are infected.[43],[44],[45] About 70% of the individuals affected with HIV usually have one or more respiratory illnesses. A study on pulmonary complications of the HIV infection demonstrated that respiratory symptoms are the common complaint among the individual having HIV-infection which is increasing frequently as the CD4 counts declined to less than 100 cells/mm3.[46] Respiratory symptoms may result from a wide spectrum of pulmonary illness which includes HIV-related opportunistic infections and neoplasm. Noncavitory infiltrates and intrathoracic adenopathy increased as the CD4 counts decreased in case of TB. A wide clinicoradiological spectrum of TB was seen among HIV patients in compatibility with their varying immune status. It has been found that the presence of cavitation was related to higher CD4 counts, indicating that a robust immune response is required for cavitation to occur.[47] Extrapulmonary TB was not associated with decreased CD4, but patients with a combination of PTB and extrapulmonary TB had significantly lower CD4 counts.[48] CD4+ T-cell counts are being used to monitor the disease progression of HIV infection. It has been found that the presence of cavitation was found to be related with higher CD4 counts. In TB, noncavitory infiltrates and intrathoracic adenopathy increased as the CD4 counts decreased. The CD4+ T-cell counts were significantly high in the controls compared to the TB patients. Since the controls have high CD4+ T-cell counts in comparison to patients with TB infection, this depicts a decrease in CD4+ T-cell immune function during active TB infection.[49] The usage of immunoglobulins intravenously in the group of patients with multidrug-resistant TB and HIV infection, with CD4+ level <50 cells/μCL, is appropriate and essential because it improves treatment outcome.[50]


  Human Immunodeficiency Virus and Lung Cancer Top


HIV infection and acquired immunodeficiency syndrome (AIDS) increase the risk of opportunistic infections and also non-Hodgkin's lymphoma and Kaposi sarcoma. These malignancies were later joined by invasive cervical cancer as AIDS-defining malignancies. Other cancers that occur excessively in HIV/AIDS patients include lung cancer, Hodgkin's disease, soft-tissue malignancies, penile cancer, lip cancer, and testicular seminoma. Frish et al.[51] also note that lung cancer relative risk increases with the progression of the disease from HIV status to AIDS disease. In a previous study, it has been found that lung cancer incidence was associated with cumulative exposure to CD4 counts <500 cells/mm3 and CD4/CD8 ratios <0.4. The overall mortality was greater for patients with lower CD4 count at the time of diagnosis of lung cancer.[52] Cell-mediated immunity plays an important role in immune responses against cancer, for example, CD8+ cytotoxic T-lymphocytes are key effector cells in antitumor immunity.[53] In hosts with tumors, however, tumor-specific CD8+ T-cell responses are usually weak. The key to this paradoxical observation may lie in the fact that CD4+ T-cell help is insufficient for driving an effective antitumor immunity. CD4+ T-cells play an important role in orchestrating antibody production as well as the activation and expansion of CD8+ T-cells by a phenomenon known as CD4+ T-cell help. CD4+ T-cell help is also required for the generation and maintenance of CD8+ T-cell memory.[54],[55],[56],[57],[58] Such CD4+ T-cell help that programs the CD8+ T-cell responses is favored at the time of CD8+ T-cell priming.[59],[60],[61] Increasing evidence has shown that CD4+ T-cells significantly contribute to tumor protection in vivo.[62] It has been shown that lung cancer incidence was also associated with cumulative exposure to CD4 counts <500 cells/mm3. Correlated survival was better for patients with CD4 count >200 and >500.


  Conclusion Top


Clinicians caring for individuals living with HIV must be aware of the wide range of noninfectious pulmonary diseases that can occur in the population. It has been found that pulmonary infections remain an important cause of morbidity and mortality and must be ruled out whenever possible. It has been suggested that future research needs to focus on understanding the mechanisms which lead to the development of respiratory diseases such as asthma, COPD, lung cancer, and TB in HIV for the improvement, prevention as well as treatment of the patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Human Immunodefi...
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