Q and A

Question

What are normal ranges for a CD4 count, the CD4% and the CD4:CD8 ratio?

Answer

CD4 cells are a type of lymphocyte (white blood cell). They are an important part of the immune system. CD4 cells are sometimes called T-cells.

There are two main types of T-cells. T4 cells, also called CD4+, are “helper” cells. They lead the attack against infections. T8 cells, (CD8+), are “suppressor” cells that end the immune response. CD8+ cells can also be “killer” cells that kill cancer cells and cells infected with a virus.

The normal ranges for CD4 and CD8 counts varies depending on the lab and test, but for an HIV negative person a normal CD4 count is in the range 460 to 1600. This is an average. Anywhere in this range is fine.

Although generally a higher CD4 is good, an HIV negative person with a normal CD4 count of 1200 is not more healthy than someone whose normal count is 400.

A normal CD8 range is from 150 to 1000. This test is not really used so much for monitoring. Knowing your CD4 count is more important.

But CD4 counts can vary from day to day and even from hour to hour. The test itself has is not alway sensitive to the exact number – just the general result.

If you ever get an unexpectedly high or low CD4 count your CD4% (CD4 percentage) will indicate if this is a real change. The percentage refers to total lymphocytes.

If your test reports CD4% = 34%, that means that 34% of your lymphocytes were CD4 cells.

This percentage is more stable than the number of CD4 cells. The average normal CD4% for HIV negative adults is about 40%. However, as with CD4 counts and other test, the range for a “normal” result in an HIV negative person is also wide – i,e. from about 25% to 65%.

The CD4:CD8 ratio is also sometimes used, but less often. This is a measure of how balanced your immune function is. This calculated by dividing the CD4 result by the CD8 result.

In HIV negative people, the normal range for the CD4:CD8 ratio is between 0.9 and 1.9. This means that there are about 1 to 2 CD4 cells for every CD8 cell.

When not on HIV treatment, just like the CD4 count and CD4%, this ratio drops over time. Eventually, unless you start treatment, there will be more CD8 cells than CD4 cells (i.e. the ratio drops to less than 1.0).

Note: this answer was updated in September 2014 from a post that was originally published in December 2006.


Information on this website is provided by treatment advocates and offered as a guide only. Decisions about your treatment should always be taken in consultation with your doctor.

27 comments

  1. Hi Jim

    You are right that your own decisions should be based on your individual results and choices. Of course, your discussions with your doctor are an important part of this.

    Individualising care is essential because what it right for you might not be right for someone else.

    Many treatment guidelines now recommend starting at higher CD4 counts for various reasons. In the UK this is still at 350, but most countries have changed to 500 and some countries recommend treatment at CD4 counts above 500. One of the reasons for this is that not being on treatment makes your immune system working overtime to control HIV. Another is to be less infectious to your partner(s).

    This means that it is more difficult to generalise about when is “absolutely necessary”. Because todays meds are generally safe and effective, some of the earlier reasons for waiting are now less important.

    Although guidelines don’t recommend starting and stopping treatment, this doesn’t mean that you can’t stop – for example if you start early and have trouble. Most people though find that treatment is much easier than they expected.

  2. jim

    I am an hiv+ man of 51. I was diagnosed 4 years ago. My CD4 dropped at one time to just below 350. That was over two years ago and my viral load was about 2500. I have held off on starting meds because my CD4 improved back to normal range 450 and my viral load has dropped to just at 400. My doctor and I have made the decision to wait on starting meds until it is absolutely necessary. Once you start meds you cant stop.

  3. Kimmie

    Hi, I’m 39 years old, I have been HIV+ for 16 plus years, I have been treated since I found out of my diagnosis, the doctor I see and research has shown the sooner you get medication the better chance you have of living. No matter what your cd4 is you should be on medication. I have been a non-progressor this could be the result of being on medications. Please seek medical help no matter what.

  4. Hi,

    A CD4 count of 410 is strong. In countries like the UK and SOuth Africa you do not usually start treatment until your CD4 falls to 350.This is because in the long run starting earlier doesn’t give you any health benefit.

    You can talk to your doctor of clinic and ask them how it works there.

  5. Busisiwe

    My CD4 count is 410, i’m not on meds so what must i do?

  6. charmain

    Hi I’m a lady of 23 and I’m hiv+and my cd4 count is 500 so I want to find out when do I need to start treatment

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