Understanding cd4/cd8 ratios

[Almost2late]

I've known about my status for over 7 years now, and positive I've had the virus for 20 yrs.

My recent cd4 count have come down a bit from 386 @16%, to 284 @17.8%, and still very much undetectable .. now I'm not sweating this cuz it is what it is.. my pinched nerve/neck/back pain situation over the summer has subsided considerably, and I'm grateful for that.. so my lowered cd4's aren't causing me any pain, isn't stopping me from doing things I want to do, took me a while to totally understand this..

I've learned a lot in this forum about how having good cd4 counts are optimal but it doesn't translate to how healthy you are.. still I want to understand the science around my immune system and would appreciate if someone would explain it to me like I'm a 12 year old..
I don't get the cd4/8 ratio thing.. what's a normal ratio and why is it important? I just can't seem to grasp this.

[Bucklandbury]

I'm not an expert, but:

A normal CD4/CD8 ratio is 2.0, with CD4 lymphocytes equal to or greater than 400/mm3 and CD8 lymphocytes equal to 200 to 800/mm3.

If your ratio is higher than 2, it means your immune system is strong and you may not have HIV.

If your ratio is less than 1, you may have:

HIV
AIDS - if your CD4 count is less than 200/mm3
Bone marrow problems related to chemotherapy
Anemia
Multiple sclerosis, myasthenia gravis, or another nervous system condition
Chronic infection

Higher than normal results may mean you have:

Major infection
Viral infection
Type of blood cancer

So... my limited understanding is that (ideally), we as PLWH want this ratio to be as close to 1.0 as possible, without going too much under or over.

Someone more knowledgeable, please correct me.

Thank you.

[Almost2late]

Thank you Bucklandbury, I appreciate your insight.

So from what I'm understanding here, for every cd8 we PLWH should have at least two cd4's?.. and normal for negatives is four cd4's for every single cd8 or better?

I know I'm screwing this up.. I'm terrible at fractions or algebra, or whatever this is. But I do know that on my last test that measured my cd8 ratio was in 2018, and it was 0.3.. does that mean cd8's outnumber cd4's 3 to 0?.. and that can't be good, right?. Lol, i hate math. Maybe explaining like I was 5yrs old rather than 12.

But thank you..

[Matths]

Hi, let me give this a try. When you were diagnosed a low CD4/8 ratio could be explained by low CD4 numbers as direct result of HIV negatively impacting the absolute CD4 count. In most cases combined with high CD8 numbers. The CD8 cells are the storm troopers fighting infection of any sort and are a marker of an activated immune system. As you have correctly pointed out, CD8 activation is also found in other situations when the immune system is (over)active, ie MS, cancer etc.

In HIV, especially once you are on ART that controls HIV and brings you to U, your CD4 counts will slowly increase and CD8 activation will end and counts decrease. Therefore, even when your absolute CD4 numbers may not increase back to a normal range (as defined by healthy people’s numbers), because CD8 numbers decrease your ratio will increase towards normal. During situations of an infection or any other situation that requires your immune system to react, you will see a transient increase in CD8 numbers suggesting a healthy immune response. Such healthy response can result in a transient decrease of the ratio CD4/8, but is nothing you should worry about.

Overall, you want to ensure you are U and shouldn’t worry much about the fluctuations in your CD4 and 8 numbers, and their ratio.

Hope this makes sense, best Matt

[Almost2late]

Thanks Matt, I think I get it now.
Both you and Buck have helped a great deal.

Now I get why my doctor hasn't checked what my cd8 count is in the past 3 years.. it's just not that important bc it's not likely to have changed much if the cd4's are relatively the same.

And I agree, what matters is keeping the viral load in check with art.

Also I think I finally figured out the math formula too, cd4's ÷ cd8's = ratio right? I feel so stupid, it was just division.

[Matths]

You are right on target!

[Tonny2]

           ojo.              Hello OP, don’t worry about things you don’t understand or ask your doctor otherwise you will not be living your life completely. Checking Our labs is the doctor’s job…you just should know your VL, cd4 and I ask for cd4%…there is life after an hiv dx as long as you live it at the fullest…good luck


Ps. Worry when your cd8 is low (DEALS) google it)

[leatherman]

the three main numbers to worry about, regarding HIV, are viral load, absolute cd4 count, and cd4%. While things like cd8s and other results might be affected by HIV and/or medications, these other results are often influenced by other issues than HIV.

CD4% is sometimes a more stable indication of whether there has been a change in the immune system. If the percentage hasn’t changed the change in the absolute count is not important.

https://i-base.info/ttfa/section-1/9-interpreting-cd4-results-cd4-count-and-cd4-percentage/

The prognostic (predictive) value of CD4/CD8 is considered less relevant to the management of HIV than it was 20 years ago when there were fewer, less effective drugs available to treat HIV. While the value can still help us determine the age of the infection and your risk of mortality, greater emphasis has been placed in recent years on sustaining viral control (as measured by an undetectable viral load).2 Doing so helps slow disease progression and avoid the development of drug resistance.

With that being said, increasing focus has been placed on the use of CD4/CD8 ratio in people with long-term HIV infection. Recent studies have suggested that people with a low CD4/CD8 ratio who have been on treatment of years are at an increased risk of non-HIV-related illness and death.

https://www.verywellhealth.com/how-important-is-your-cd4-cd8-ratio-48781

I ask for cd4%

personally, unless while my cd4 <200 or when I changed meds, I have never really paid attention to the cd4%. For that matter, once my absolute cd4 got over 350 (an arbitrary number I picked because after years of being well under 200, 350 seemed like a really good, high count to me ) I really haven't worried about my cd4 count, except for being happy that after 29 years of meds, I am holding nicely at UD with a cd4 count in the low 400s finally.

[Tonny2]

the three main numbers to worry about, regarding HIV, are viral load, absolute cd4 count, and cd4%. While things like cd8s and other results might be affected by HIV and/or medications, these other results are often influenced by other issues than HIV.
https://i-base.info/ttfa/section-1/9-interpreting-cd4-results-cd4-count-and-cd4-percentage/
https://www.verywellhealth.com/how-important-is-your-cd4-cd8-ratio-48781
personally, unless while my cd4 <200 or when I changed meds, I have never really paid attention to the cd4%. For that matter, once my absolute cd4 got over 350 (an arbitrary number I picked because after years of being well under 200, 350 seemed like a really good, high count to me ) I really haven't worried about my cd4 count, except for being happy that after 29 years of meds, I am holding nicely at UD with a cd4 count in the low 400s finally.

           ojo.               Hi leather man…I got used to asking for the cd4% after having treatment failure since dx in 1994, finally, by the year 2000, I got a treatment that worked raising my cd4 from zero to 361, it was then when my doctor started talking to me about cd4%. Ever since then, I always ask for VL, absolute cd4 and cd4%…your story is more or less like mine but, the difference now is that my cd4 have been between 600 and 800 and my cd4% in the range of 29 and 33 for the last two or three years. I’ve been taking the same treatment for 14 years with great results, too bad I didn’t have this treatment before I lost most of my vision, but, I’m still alive…I’m glad you finally hit 400 though…good luck mikie

[J.R.E.]

personally, unless while my cd4 <200 or when I changed meds, I have never really paid attention to the cd4%.

That's how I feel. In 2003, when I had 16 tcells and a CD4 percentage of about 5%, I was watching both, as I was at single digit for what seemed like an eternity.

Now my cd4 % is at 17, and I rarely look at that number any more. The main thing is I am undetectable, and my CD4 are at 571.  17% is the highest my CD4 % has been in 18 years, after starting on HAART.


Ray

[Almost2late]

                ojo.              Hello OP, don’t worry about things you don’t understand or ask your doctor otherwise you will not be living your life completely.

the three main numbers to worry about, regarding HIV, are viral load, absolute cd4 count, and cd4%. While things like cd8s and other results might be affected by HIV and/or medications, these other results are often influenced by other issues than HIV.

Thank you guys, you're right.. but I'm not really worried about the cd8's.. I'm just trying to understand them as they pertain to the immune system. I learned a little bit more about those numbers on that medical chart, even if it's below the 1.0 ratio.. I'm good.

And thanks for the links..