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.
36 male.
I was infected with HIV only 12 weeks ago.
I was diagnosed 8 weeks ago, with a CD4 count of 250, but at 28% and ratio 0.9, and viral load of 48,000. I’m still trying to make sence of it all.
I’ve been on medication (Striblid) for two weeks now and have had a bad rash break out which is slowly fading. Still scared and uncertain but also trying to look at a brighter side of life.
Thank you for this!
My D Day was May 12th, 2003. VL = 220,000, and cd4 = 105. I had AIDS with complications. Started treatment. Was undetectable a year later.
Today, I’m still undetectable with a cd4 count of 1800-2000+ for the past year. My cd8 count on the latest test was 810. I go to a VA hospital who treat over 1,200 HIV+ veterans routinely. I’m told my blood scores are in the highest 1%.
61 years old, male, and my only vice is smoking. I have COPD and afib that is being controlled. I’m also very overweight. Over time I’ve gained nearly 100 pounds since being diagnosed with AIDS in 2003. However, I feel great.
I’d advise to not delay taking HIV meds if you can get and/or afford them.
Get undetectable at once, and don’t let this virus get a foothold on your body. I’d rather act on the side of caution, and there’s too much they don’t know yet on the long term effects of allowing the virus spread especially for the brain and digestive system.
The meds I’ve taken are perfect with zero side effects. What was first thought to be a side effect turned out to be that I needed to eat much more fiber. Problem solved. Not all health issues or caused by HIV. Look for other causes, too.
Hi Jim
You are right that your own decisions should be based on your individual results and choices. Of course, your discussions with your doctor are an important part of this.
Individualising care is essential because what it right for you might not be right for someone else.
Many treatment guidelines now recommend starting at higher CD4 counts for various reasons. In the UK this is still at 350, but most countries have changed to 500 and some countries recommend treatment at CD4 counts above 500. One of the reasons for this is that not being on treatment makes your immune system working overtime to control HIV. Another is to be less infectious to your partner(s).
This means that it is more difficult to generalise about when is “absolutely necessary”. Because todays meds are generally safe and effective, some of the earlier reasons for waiting are now less important.
Although guidelines don’t recommend starting and stopping treatment, this doesn’t mean that you can’t stop – for example if you start early and have trouble. Most people though find that treatment is much easier than they expected.
I am an hiv+ man of 51. I was diagnosed 4 years ago. My CD4 dropped at one time to just below 350. That was over two years ago and my viral load was about 2500. I have held off on starting meds because my CD4 improved back to normal range 450 and my viral load has dropped to just at 400. My doctor and I have made the decision to wait on starting meds until it is absolutely necessary. Once you start meds you cant stop.
Hi, I’m 39 years old, I have been HIV+ for 16 plus years, I have been treated since I found out of my diagnosis, the doctor I see and research has shown the sooner you get medication the better chance you have of living. No matter what your cd4 is you should be on medication. I have been a non-progressor this could be the result of being on medications. Please seek medical help no matter what.
Hi,
A CD4 count of 410 is strong. In countries like the UK and SOuth Africa you do not usually start treatment until your CD4 falls to 350.This is because in the long run starting earlier doesn’t give you any health benefit.
You can talk to your doctor of clinic and ask them how it works there.
My CD4 count is 410, i’m not on meds so what must i do?
Hi,
This depends on which country you live in. In the UK and South Africa treatment guidelines recommend that you start when your CD4 count falls to 350. In other places like the US it’s 500.
You can find more information on CD4 count and starting treatment here:
http://i-base.info/guides/starting/cd4-count-and-guidelines
Hi I’m a lady of 23 and I’m hiv+and my cd4 count is 500 so I want to find out when do I need to start treatment