Q. My CD4/CD8 ratio is 1. 06. Does it indicate a HIV infection?

Answered by
Dr. Ravinder Kaur Sachdeva
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 06, 2018

Hello doctor,

I had a possible high-risk exposure four months back, and I am worried about HIV infection. I got a fourth generation PCR, PCR for HIV2, and viral load, which were all normal. I still have symptoms like diarrhea and joint pain. Just last week I did a CD4 panel, and this is the results, the absolute CD4 helper is 937, percentage CD4 is positive, the absolute CD8 suppressor is 886, percentage CD8 is positive, lymphocytes is 32.8, CD4/CD8 ratio is 1.06, WBC is 12.2, and neutrophils absolute is 8.9. My concern is the CD4/CD8 ratio, I read that a number below 1 might be HIV, and I am so close to 1. Also, my WBC and neutrophils are high. Do you know what it means?



Welcome to icliniq.com.

Let me answer your questions step by step.

  • A negative fourth generation test and HIV RNA PCR at four months is highly conclusive that you are HIV (human immunodeficiency virus) negative.
  • Diarrhea and joint pains could have multiple reasons, not necessarily HIV. In fact, there are no HIV-specific signs and symptoms, which confirm the diagnosis of HIV. Get a consultation with a GP. You might require specific tests for diarrhea and joint pains.
  • A normal healthy individual has CD4 count between 500 to 1500, your CD4 count is 937 which is absolutely normal. The CD4/CD8 ratio is a reflection of the immune health system. The normal CD4 count is higher than CD8 and the normal ratio is between 1 to 4. Your ratio is 1.06, which is absolutely fine.
  • The other thing is that in the first six months of HIV infection, CD8 count increases up to 40 to 50 %, which then inverses the ratio to less than 1. There is seasonal and diurnal variation in the counts too, which affects the ratio. It is also affected by any coexisting viral infections, tuberculosis, autoimmune conditions, corticosteroid therapy, immunosuppressive drugs, etc., and there are so many other factors which affect the ratio. In your case, the panel which included CD4, CD8, and CD4/CD8 is normal.
  • Generally, an increase in the WBC and neutrophils is seen in bacterial infection. 95 % of people who are infected with HIV, develop antibodies by 2 to 8 weeks and up to 5 % seroconvert by the third month. Rare cases of late seroconversion at six months has also been reported in the literature.
  • There are recommendations, and I also suggest my patients repeat HIV antibody test at six months of unprotected exposure, especially, if you have any doubt about the exposure.

Hope your queries are answered, but if you still have any other question please do not hesitate to ask. 

For more information consult an HIV AIDS specialist online --> https://www.icliniq.com/ask-a-doctor-online/HIV-AIDS-specialist

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