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Assessing the Prognostic Significance of CD8+ T-Cell Counts in Determining the Risk of Myocardial Infarction in the Setting of HIV Infection

Badejo, Oluwatosin A. (2013) Assessing the Prognostic Significance of CD8+ T-Cell Counts in Determining the Risk of Myocardial Infarction in the Setting of HIV Infection. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

There is a growing body of research to suggest that Human Immunodeficiency Virus (HIV) infection is associated with an increased risk for myocardial infarction (MI) although the underlying processes remain unclear. An assessment of MI risk using a commonly-available measure of the immune status is therefore of Public Health importance. CD8+ and CD4+ T-cell counts are periodically measured in the routine management of HIV-infected patients. However, CD8+ T-cell counts are often not reported or are simply incorporated into the calculation of a CD4+/CD8+ ratio. Total CD8+ T-cell counts have been shown to be associated with an increased risk for MI in at least one recent study. A few other studies have examined this association indirectly by using the CD4+/CD8+ ratio, but only considered MI surrogates (e.g. subclinical coronary atherosclerosis) as an outcome. Also, measuring cell-surface markers of CD8+ T-cell activation and HIV-specific CD8+ T cell counts is costly and often not requested in the routine management of HIV infection.
This study investigated the association between total CD8+ T-cell counts and MI risk among a large cohort of HIV-uninfected and HIV-infected Veterans. Using Cox proportional hazard regression models, the results suggest that MI risk is associated with a high CD8+ T-cell count of ≥1066 cells/ mm3 (Adjusted HR = 1.82, P <0.001, 95% CI: 1.46 to 2.28). They also suggest that the risk for MI posed by total CD8+ T-cell counts should be interpreted in the context of CD4+ T-cell clinical cut-points, or the overall immune status. The degree of MI risk in the cohort differed depending on the level of the immunosuppression. Total CD8+ T cell-counts seemed to modestly improve the risk stratification provided by CD4+ T-cell clinical cut-points, though the mechanisms are still unclear. Future studies will be instrumental in understanding the role of the immune system in MI risk prediction.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Badejo, Oluwatosin A.oab4@pitt.eduOAB4
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorWilson, Johnjww@pitt.eduJWW
Committee MemberHo-Chang, Chung-Chouchangj@pitt.eduCHANGJ
Committee MemberFreiberg, Matthewfreibergms@upmc.edu
Date: 27 June 2013
Date Type: Publication
Defense Date: 11 April 2013
Approval Date: 27 June 2013
Submission Date: 25 April 2013
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 60
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: myocardial infarction, immunosuppression, CD8+ T-cell count, CD4+ T-cell count, proportional hazards regression, Kaplan-Meier survival estimates
Date Deposited: 27 Jun 2013 18:04
Last Modified: 01 May 2018 05:15
URI: http://d-scholarship.pitt.edu/id/eprint/18603

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  • Assessing the Prognostic Significance of CD8+ T-Cell Counts in Determining the Risk of Myocardial Infarction in the Setting of HIV Infection. (deposited 27 Jun 2013 18:04) [Currently Displayed]

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