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 Mark, no you do not need to worry. Your CD4 count is well in the range of someone who is HIV negative (or is positive and on ART).
Is there a reason you have had a lymphocyte test done?
Hi Team,
My Test of Lymphocyte Marker in April 2022 is the following:
CD3% 72.4
CD3 Count 1706
CD4% 45.7
CD4 Count 1076
CD8% 23.8
CD8 Count 561
CD4/CD8 1.9
Last time I made HIV test was Negative in 2015
Is these results abive normal, do I have to worry?
Thanks
Hi Bill, thank you for sharing this. It’s great to hear that your medication is working this well.
Get on meds. Was diagnosed in 2019 at 52 and immediately got on meds. They worked!!! Undetectable within months of getting on them and have stayed that way for years now. My wife and I have unprotected sex and she has never had any issues or concerns once she understood that I can no longer transmit the disease.
Hi Pitchaiah, these are not results from an HIV test. You will need a specific test for HIV to confirm your status. Please follow this link to learn more: https://i-base.info/qa/257
Sir,
My total leucocyte count 3800
Cd45(lymphocytes) percentage. 88.5
Cd45(lymphocytes) absolute 3364.98
Cd3(total t cells) percentage 60.16
Cd3(total t cells) absolute 2024.24
Cd4(helper t cells) percentage 39.90
Cd4(helper t cells) absolute 1342.61
Cd8(cytotoxic t_cells) percentage 20.54
Cd8(cytotoxic t cells) 691.02
My cd4/cd8. Ratio 1.94
Sir plz tell me I am HIV positive or negative
Hi Pitchaih, these results do not indicate if you are HIV positive or negative. Your CD4 count would suggest you are not given how high it is. This means you have a very healthy immune system. You will need an HIV test if you are unsure of your status. Please see this link about testing: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Sir,
My total leucocyte count 3800
Cd45(lymphocytes) percentage. 88.5
Cd45(lymphocytes) absolute 3364.98
Cd3(total t cells) percentage 60.16
Cd3(total t cells) absolute 2024.24
Cd4(helper t cells) percentage 39.90
Cd4(helper t cells) absolute 1342.61
Cd8(cytotoxic t_cells) percentage 20.54
Cd8(cytotoxic t cells) 691.02
Sir plz tell me I am HIV positive or negative
Hi Joseph, thanks – these results look – though I really need to know the results form April to see how they have changed. The most important result is the CD4 count which is very good at 447 cells/mm3 (although it is written in a strange way). I assume that this is higher that when you started in April. You would also expect your CD4% and CD4:CD8 ratio to also both be higher than in April. Have you had a viral load test result yet? This should be undetectble by now.
Hi There,
I received my results after starting treatment back in April, should i be concerned that the medication (Biktarvy) is failing? If so what is the next steps in terms of medication.
Can you please explain the results below, i would greatly appreciate it.
Results:
% CD4=25
Abs CD4 Lymphocyte Cnt =0.447 10*3/uL
% CD8= 42
Abs CD8 Lymphocyte Cnt= .766 10*3/uL
CD4/CD8 Ratio = 0.58