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 Enrrique,
The CD4% is the percentage of white blood cells that are CD4 cells. And CD4 percentage of 17% would mean an absolute CD4 count of round 200 to 300 cells. The CD4:CD8 ratio should be 1 or 2 CD4 cells for evry CD8 cell. So I’m not clear about that part of your question.
Here’s a guide to different types of HIV tests which you can check against the ones you’ve had.
ive been tested negative to hiv by 4th gn elisa ,pcr rna and p24 antigen after 4 years of pontentially getting the virus. have a cd4 count of 1006 16.7%and a cd8 of 950 15.8% can i be seronegative and still have hiv?
Hi Sibongile,
Its not possible to have a CD4 count of 401,000 are you possibly referring to her viral load? If it is her viral load and she’s been on meds for 10 years, then yes this is normal. This is because the meds aren’t working like they should be.
My niece’s CD 4 count is very ,high she says 40100 . She had been HIV over 10yrs and on ARVs. Treatment was changed on Monday . Is that a course for concern
Hi Jo,
Have you started HIV treatment (ART)? And do you know your viral load result?
Your CD4 count is a measure of your immune system, and 22 means that your immune system is currently very vulnerable to infections – so the sooner you start ART the better.
Hopefully you may have already started by now, or are planning to start this week.
Because your CD4 count is below 50 you should also have an eye exam (for CMV). Until your CD4 count gets over 200 (and it will on treatment) you will also need to take an extra antibiotic medicine called Septrin to reduce the risk of other infections.
Once on ART your viral load should drop dramatically. Your CD4 count will slowly increase. So this is good reason not to worry or to be scared.
Please see this link to the Introduction to ART guide.
What to do if cd4 is 22
Hi Omole,
The most important thing to do when someone is diagnosed with a low CD4 count is to start medication. Its the ARVs that will help your CD4 to recover. Ideally you should be getting specialist care and following the advice that is in this link:
http://i-base.info/qa/4643
My CD4 is 6, what can I do?
Hello Ashok,
Have you started HIV treatment (ART)? Please see this similar question here. The good thing is that ART can work at any CD4 count, even when the count has become very low. Can you talk to the doctor about monitoring for infections such TB which can flare up when you start ART because your CD4 count can start to recover.
Have you got access to treatment where you live?
Brother cd4 10 pl help me