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.
An intriguing discussion is worth comment. I think that you ought to write more about this subject, it might not be a taboo matter but generally people do not discuss these issues. To the next! Best wishes!!
Hi Joyce, deciding when to talk to an HIV positive child about thier health involves care to this carefully – just as the care you already show when looking after her. It is not clear whether you the guardian or career. If yes then talk to the clinic about this. If her mother is still looking after her you can talk about this together. Definitely start with he Mum.
hi my mums last born was born HIV positive but she began treatment last year and added TB treatment this year. what bordering me is of how am I going to let her know her status. she is only 9 years and she is already telling me how sick and tired she feels of he treatment. I even had to lie that I also had to go for the same when I was of her age. sisters wants us to tell he the truth. is it a right time?where shall we start with mum?
Yor son is HIV negative and this service is about HIV. Teh doctor nees to explain these results to you and what they mean. I am not a doctor.
My son is HIV negative but has low CD3 and CD4 percentages,50 and 30 respectively, elevated natural killer cells,33 and ABS NK cells 981, elevated RBCs 5.47,and albumin 4.9, ABS mono’s .9 hi, ABS eos .4 (hi), IgE 777 “sky high” per doc, Low anion gap 5, and Hi Influenza A Ab IGg 1.84…doc’s find no reason for concern or follow up in spite of systemic symptoms and recurrent infection, cutaneous manifestations…He’s 18, now considered adult so need to find new docs..the last infectious disease only ordered HIV and drug screen, negative naturally..I’m desperate and worried to find out what is wrong with my son and would appreciate any input from other’s with any experience with these types of labs…I’m ill as well and ironically, have low anion gap, so did my sister who just passed away…not sure if possible genetics involved, sis had severely elevated platelets, have alot of cardiovascular stuff going on in family history..want him to lead a healthier life than all of us did! thanks so much for your consideration and any help or suggestions are greatly appreciated!
Hi Onias,
I’m sorry that your wife has had these miscarriages. But the good news is that many women who are HIV positive and on HIV treatment have healthy HIV negative babies.
A CD4 count of 650 is strong. So could there be other health problems that are causing this?
You and your wife can talk to the doctor about why this is happening. It’s good that you are supporting and assisting her on treatment.
Could you let me know how it goes?
Best wishes
Hi, i got married to a HIV woman in 2012 and we are still together. This didn’t change my love for her. I was assisting her with what ever healthy wise until she started treatment two years ago. She started treatment when her CD 4 were below 250 and now the CD 4 are at 650. The problem is she did two miscarriages and we still need a baby, i want to know if CD 4 affects a woman to have a baby?
Hi, Once you’re on treatment and your viral load is undetectable your immune system will repair itself and your CD4 count will increase. But this usually goes slowly.
Your question has already been answered here.
I’m HIV positive and I wish my CD4 will increase fast, I cannot wait to live a normal life again
Hi, It’s good that you’re taking ARVs and using condoms too.
But stress can affect your health. You can talk to your doctor about your work stress levels, and also ask if stress could be a side effect of your ARVs.
You can find out about ARV side effects such as anxiety and mood changes here.