Question
What is a normal CD4 count, CD4% and CD4:CD8 ratio?
16 January 2018. Related: All topics, CD4 and viral load, Other tests.
Answer
After finding out you are HIV positive, your doctor will run several blood tests.
One will be for your immune system and will include your CD4 and CD8 count. Of these, the CD4 count is the most important main result but the CD4% and CD4:CD8 ratio are also sometimes useful.
This Q&A include information about these cels and about interpreting the test results.
CD4 cells are a type of blood cell that is part of your immune system. They are a type of white blood cell (lymphocyte). CD4 cells are sometimes called T-helper cells or T-cells
There are two main types of T-cells.
- CD4 cells, also called T4 cells, are “helper” cells. They lead the attack against infections.
- CD8 cells, (T8 cells), are “suppressor” cells that complete the immune response. CD8+ cells can also be “killer” cells that kill cancer cells and other cells that are infected by a virus.
CD4 and CD8 counts
The normal ranges for CD4 and CD8 counts vary depending on the lab and test. On average, the normal CD4 range for an HIV negative person is between 460 and 1600. This is an average. Anywhere in this range is good.
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.
The exact CD4 count is not so important. CD4 counts can vary from day to day and even from hour to hour. So the general CD4 result is more important than the exact number.
A normal CD8 range is from 150 to 1000. This test is not used as much but the results come together. It is more important to know your CD4 count than your CD8 count.
CD4 percentage (CD4%)
If you get a CD4 count that is ever unexpectedly high or low, then your CD4% (CD4 percentage) can show whether this is a real change in immune function. The CD4% is a more stable marker than the absolute CD4 count.
The CD4 percentage refers to percentage of total lymphocytes that are CD4 cells. If your test reports CD4% = 34%, that means that 34% of your lymphocytes are 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 – from about 25% to 65%.
CD4:CD8 ratio
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%, the CD4:8 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).
The CD4:CD8 ratio might be better at predicting future risk in people whose CD4 count is high (above 500 cells/mm3). However, not all studies agree on this.
Other studies have shown that starting ART soon after HIV infection has a much higher chance of keeping the CD4:CD8 ratio higher than 1.0.
Note: this answer was last updated in January 2018 from a post that was originally published in December 2006.
Hi Matthew,
Have you talked to your doctor about your symptoms and asked for your CD4 count result? You can ask for more tests for this and all your symptoms.
Hi Mohan I have similar problem I had intercourse, 2weeks after I started having first small symptoms, 1 month after had serious symptoms so started testing, leukoplakia and receding gums after 1,5 months, done 2 hiv rna pcr tests and 4th gen after 3,5 months all negative, but I’m ill all the time with hiv related symptoms ( no hunger,dry mouth, leukoplakia, opportunistic viral infections of throat, weight loss, I feel very small pain in my lymph nodes in armpits and neck from time to time).
Hi Mohan,
I hope you don’t mind, but I edtied your comment because it was a bit long and I didn’t understand it. So I’m not sure about some of what you say.
However, as you have tested HIV negative your CD4 count is not relevant. Viral load tests for HIV RNA are not approved for diagnosing HIV.
It’s a good idea to see your doctor about all your symptoms.
Hi i recently fell ill with aids related complications. I had unprotected sex 5 years ago and never tetsed for HIV. Now i got tested based on the symptoms I have and tested negative on the 4th gen elisa and western blot.
I have all aids related symptoms like oral hairy leukoplakia, ADC and muscle loss and insomnia. My hands go numb when i sleep. Have neurological problems as well with blurry vision. Recently i have difficulty swolling and digestive system is fully compromised. I also did a cd4 test and cd4 count is only 469 which is way low then the average healthy count. How can someone have so less cd4 count and test negative for HIV.
I am deciding to conduct Rna Pcr quantitative to see if i have any HIV copies in my blood to completely rule out HIV.
Hi Mojo,
As you can see from the Q&A above, your results look as though they fit into the normal range.
Is there a reason why you think the 3 months test is not accurate? Do you have any symptoms? Have you talked to the doctor about this?
Hi!
My CD4 result is as follows:
CD3 Count – 1054; 75% (Ref Range 60-85)
CD4 Count – 488; 35% (Ref Range 30-50)
CD8 Count – 513; 36% (Ref Range 10-35)
CD4/CD8 Ratio – 0.95 (Ref Range 0.7-3.5)
My HIV 4th Gen test was negative at 3 months. Is there a possibility of infection, as my numbers are borderline? I am really worried about HIV2 as it causes slow decline in CD4 and window period is also longer than HIV1. Very confused and worried.
What do you think. Please advice.
Hi Greg
Thanks for your comment. This answer for normal ranges of lab results is still accurate – although at the bottom of the original paost it ways the answer from 2006 was already updated in January 2018.
We can’t update every answer – hence the caution to check the date – but we do update some of the most widely read pages when we see they need updating.
Ok these studies are from 2006…says so right there, my question is, will you study these numbers again and give out an dated version of these statistics…keep people updated in information that will not be harmful…
Hi Pedra,
i-Base no longer answer individual questions about risks of HIV transmission or HIV testing.
But please see this guide to different types of HIV tests.
CD4 counts do not indicate HIV infection. HIV RNA PCR tests are not recommended for HIV testing except in specific circumstances.
hi Guys. my Hiv Ab test and pcr test after 29 Month is negative . but my cd4 test is 570 25% . Are am i Hiv Negative ???? Or Not???