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What about your CD4/CD8 ratio

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Everyone seem to be focused on CD4 percentage but I remember my doctor once told me that the ratio of CD4/CD8 is very important while evaluating the strength of immune system . I know that my ratio is 1.15.   Normal ratio range is 0 to 4(if my memory is good). That means I have more CD4 than CD8 which is good. 

Would someone know more about that ?



Hey Jacques,
Funny you should bring this up. I was just speaking about his to the infectious disease nurse specialist for this part of the state in which I live.
They don't perform the test here. I wish they did, just so I could have another indicator of how I and others are doing.

Of course, just getting the viral loads done here is a pain in the ass. Someone just called me Thursday saying instead of having a viral load test performed, the dummies at the local hospital did an HIV test.




CD8 T-cells or ‘cytotoxic T-lymphocytes’ are white blood cells that find and kill infected cells in the body, including HIV-infected cells.  Dr. Susan Little wrote this pretty comprehensive Q&A at website explaining the complex relationship between CD4 and CD8 in HIV infection:LINK

Dr. Little:  "This question has been forwarded to me since I specialize in primary HIV infection. CD8 cells are a type of white blood cell that is involved in fighting certain types of infection (such as HIV). The total CD8 cell count actually goes down immediately following infection (as does the CD4 cell count) for about 2-3 weeks - then over the course of the next month (i.e. roughly the second month of infection), the CD8 cell count increases (as does the CD4 count) to values higher than are typically seen in HIV negative individuals. During this period, the changes in the CD4/CD8 ratio are quite typical for HIV - though can be very difficult to distinguish from other viral infections such as EBV (i.e. mono). The CD4/CD8 ratio is an indicator of the overall level of immune suppression or damage done by HIV. The lower the CD4/CD8 ratio, the worse the damage. The CD4/CD8 ratio is rarely less than 1.0 in HIV negative individuals, but may drop as low as 0.1 in patients with recent HIV infection or very advanced disease. There is almost always substantial recovery of this ratio, even without antiretroviral therapy, during the 2-3rd month of HIV infection, which then persists for some time. The CD4/CD8 ratio will generally gradually decline over years of HIV infection in the absence of antiretroviral therapy. With therapy (administered fairly early after infection) this ratio may again rise to above 1.0 - a recovery rarely seen in patients with more advanced HIV infection who start on treatment.

The rate of CD4 cell count decline over time is difficult to predict without more information - but in general the rate of decline is proportional to the viral load (i.e. the higher the viral load, the more rapid the CD4 decline). For example, someone with a relatively stable viral load of 100,000 copies/ml might be expected to drop 50-100 CD4 cells per year. Much lower viral loads are associated with generally slower rates of CD4 decline. The decision of when to start treatment is very complex and in my opinion, should be very individualized. I follow the CD4 number, but if this is low because the total WBC count is low for some reason, then I follow the CD4 percentage and the viral load as the best indicators of the risk/rate of disease progression and then advise on the relative risks and benefits of treatment. In general, most physicians strongly advise treatment when the CD4 count is below 200. Between 500 and 200, there is much more room for weighing the pros and cons for each individual person before making this decision.

Finally, the CD4 and CD8 cell counts during the first 2 months of infection may reach very low levels (i.e. CD4 may fall below 200) - since there is nearly always some degree of recovery of these counts - without treatment - during the next couple of months, I would not be TOO concerned about how low the numbers go during this period - other than to say that the people who drop their CD4 cell counts the lowest, will probably have higher Viral loads after the seroconversion illness period resolves. Good luck."

Hello Jacques,

Just to add, here is some info from the lessons section ;

What is a T8 Cell Count, and the T-cell Ratio?

T8 cells, also called CD8+ or Suppressor cells, play a major role in fighting infections such as HIV. A healthy adult usually has between 150 and 1,000 T8 cells per cubic millimeter of blood. Unlike T4 cells, people living with HIV tend to have higher-than-average T8 cell counts. Unfortunately, nobody fully understands the reasons for this. Therefore, this test result is rarely used in making treatment decisions.

Lab reports may also list the T-cell (CD4+/CD8+) ratio, which is the number of T4 cells divided by the number of T8 cells. Since the T4 count is usually lower than normal in people living with HIV, and the T8 count is usually higher, the ratio is usually low. A normal ratio is usually between 0.9 and 6.0. Like the T8 cell count, nobody really knows what this low number means. However, most experts agree that once anti-HIV therapy is started, an increase in the T-cell ratio (i.e. a rising T4 count and a falling T8 count) is a telltale sign that drug treatment is working.


This is GREAT information!  I'm new to this and trying to find and absorb as much info as possible of when to start therapy.  I've been told not to worry so much about my high VL, but without detailed information of "why" I still tend to worry.



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