More CD8 than CD4 ?

[John2038]

There is an incoherence between the report presenting the percentage of CD4 and the bone marrow biopsy.

Here is an excerpt of the two reports:

Report CD4 (Nov-20-2007)

CYTOMETRIC ANALYSIS AND MONITORING

CD4 CELL% 18.03% L 30-60
CD4 CELL COUNT 487 / uL L 600-1500

Report BIOPSIE (Nov-14-2007)

IMMUNOPHENOTYPIC ANALYSIS

Markers RESULT
------- -------
Cd4 4%
..
Cd 8 11.2%

INTERPRETATION
----------------

T-cells comprise ~ 17% of the cells. They have a reversed CD4: CD8 ratio

Questions

1) If the percentage indicated in the first report is the ratio of CD4/CD8 (18.03% here), how is it that the biopsy has 4% of CD4 and 11.2% of CD8, so a ratio of 4/11.2 = 35.7%

2) What is meant in the interpretion of the biopsy in the following sentence: They (T-cells) have a reversed CD4: CD8 ratio ?

[Central79]

Hey

1. The answer to this is that you're not comparing like with like. CD4 percentage in your cytometric analysis is the proportion of all lymphocytes that are CD4+. The reason the proportion is different in the immunophenotypic analysis from your bone marrow is because other cell types are included as well. The bottom line gives it away - the interpretation of the CD4 results after this is taken into account is very close to the CD4 percentage in your peripheral blood (17 and 18.03%).

2. The CD4:CD8 ratio is normally about 2:1, i.e. there are two T-helper cells (CD4) for every T-killer (CD8) cell. The helper cells do just that - help the CD8 cells work effectively at killing pathogens by activating and directing them. As HIV infection gradually wears away at the CD4 cells this ratio flips - "reverses", to the point that the ratio is instead 1:2 causing immune system impairment.

Hope this answers your questions.

Matt.

/Edited for spelling.

[John2038]

Thank you Matt !

Sorry, 2 more questions that I hops short.

Q1) Am I in the primo-infection ?

If so, could I expect a re-reverse of the CD4:CD8 ratio ?
Note: Latest lymphocytes count: Nov 21, 2007  65.1% 3.74 x10^9/L (reference = 1.0-4.0)


Reasons of thinking so

I) On May 2007, the "hiv paper test" (very sensible to the antibodies) was positive, but not the lab test (made 2h after). The"windows period", and I can't imagine to decrease so fast as I have been till then almost never sick.

II) Counts bouncing a lot

a) CD4 / VL / %

Sept 26 (pm):   509 / 1732 / 18.7%
Nov 7 (am):      381 / 5030 / 17.2%
Nov 12 (pm):    543 /    -    / 18.2%
Nov 19 (am):    364 /    -    / 24.29%
Nov 20 pm :     487 / 3371 / 18.03% (follow-up test due to the result of Nov. 19)

b) Neutrophilis  x10^9/L (reference = 2.0-7.5)

Sept 26, 2007 26%   1.32
Nov 07, 2007   8.4% 0.29
Nov 14, 2007  14.3% 0.62
Nov 17, 2007  24.5% 0.77
Nov 21, 2007  28.2% 1.62

c) Lymphocytes x10^9/L (reference = 1.0-4.0)

Sept 26, 2007 65.0% 3.29
Nov 07, 2007  74.8% 2.63
Nov 14, 2007  72.6% 3.14
Nov 17, 2007  63.4% 1.99
Nov 21, 2007  65.1% 3.74

III) While I was nearly diagnosed having a neutropenia, the situation on the neutrophilis count have reversed.
This is a argument (IMHO) in favor of a immune system adaptation or being doing a primo-infection.

Q2) Should otherwise conclude that the time has come for me to start HAART ?

Many thanks for your valuable feedbacks.

[EDIT]: Added counts