Subclinical Reactivation of Cytomegalovirus Drives CD4+CD28null T-Cell Expansion and Impaired Immune Response to Pneumococcal Vaccination in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

摘要

BackgroundInfection is the leading cause of death in antineutrophil cytoplasmic antibody–associated vasculitis (AAV). Expansion of CD4⁺CD28^null T cells is associated with increased risk of infection and mortality, but is only present in cytomegalovirus (CMV)–seropositive individuals. We hypothesized that subclinical CMV reactivation drives CD4⁺CD28^null T-cell expansion, that this is associated with impaired immune response to heterologous antigens, and that antiviral therapy may ameliorate this.