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 Mary,
A CD4 of 1094 and an undetectable viral load is excellent. You’re in control of your HIV.
My viral load is undetectable my CD4 count is 1094 is that good?
Hi Calvin, your situation sounds complicated but I am sure that there will be lots of options.
I am very worried that you have stopped all your meds though as this is more likely to make everything worse. Without ARVs the viral load will go much higher very quickly. This will reduced immune function in your gut, as will the drop in CD4 count that will also happen. As your CD4 count is already under 200, you need to be back on ARVs before it drops any further. Even someone with drug resistance is better to be on certain drugs than on nothing.
My first questions are (i) which country are you writing from? and (ii) when is your next appointment? Please contact your clinic to see your doctor asap, certainly within a week.
Secondly, if you can email me more details of your HIV history and treatment history, it is easier to talk about other options. It is very rare for someone to really have no options. It is much more likely that with expert advice there are other things to try. Have you used an integrase inhibitor called dolutegravir, for example?
Thirdly, the root cause of your gut problems, and managing the symptoms needs to be a priority. Modern HIV meds are not likely to be making this worse, but again, having more details will make discussing options much easier. some people are very sensitive to all or some drugs, so your doctor needs to work with you to find the best ones for you.
If you would prefer to contact me directly (rather than posting everything online, please email: questions@i-Base.org.uk saying this is for my attention. If you are in the UK, we also run a free phone for treatment information:
http://i-base.info/qa/phoneline
This online guide talks about options for changing ARVs if you have drug resistance:
http://i-base.info/guides/changing
Hello,
I’ve been having years of problems adhering tonARVs usually caused by severe gut problems,
I have recently had to stop Evotaz and Descovy and that was meant to be my last option, my current labs are Cd4 185 down from 322. Cd4 % 10 down from 15, viral load 20895 up from 77.
Would the problems I am having with my Gut be the main problem for this.
I’ve been positive for 31yrs.
Can you advise the next step if any. I haven’t stopped persevering.
Hi Asa, thanks for your comment. It is great that you want to have a baby with your boyfriend. This is now really easy and safe to do without HIV being a risk. This just needs your boyfriend to be taking HIV medicines and for his viral load to be undetectable. Is your boyfriend on treatment? Also, does he get a viral load test? Having an undetectable viral load on treatment is more important than the CD4 count.
Hi
My boyfriend is Hiv positive and I’m Hiv negative the problem is we want to know how much must be his cd4 count for use to not use a condom because we want to make a child
Hi Raz, please see Q1 and the linked info. CD4 tests are not used to diagnose HIV.
http://i-base.info/qa/what-are-the-most-asked-questions
Hi, I had exposure in August with hiv positive girl and it was partially unprotected. since then I had multiple hiv test in Australia over 3 months period. All tested negative. Due to several symptoms I still can’t believe my test results. Do you think I should do more hiv test? Does this cd4 test gives indication for hiv?
Hi Zero, thanks for your question – and it is not weird. The fear we all have from HIV means it takes a while to realise just how effective modern HIV meds are. You already have a very strong CD4 count and taking your meds carefully means your life expectance is similar to someone who does not have HIV. Cutting down on drinking and smoking is a good idea, as these are leading causes of serious health problems. Great you have found a partner who is sticking with you :)
Hi, sorry I have a weird question.
If I stay on drugs for the rest of my life, stop drinking and smoking and other crazy vices. Can I live a normal life span.
My cd4 is 726, tested positive two months ago, I react to septrin so I am not on it but I am on ART. I am asking cos the girl I just started seeing is negative and she wants to stay despite my status. I want to be sure I won’t leave her 10years down the line cos of HIV before I agree.