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, how are you doing? The most importnat results here is your CD4 ABS and %.
The CD4 ABS is the absolute count of your CD4 cells. These cells make up your immune system. The lower the number the weaker your immune system. A healthy range for CD4 ABS is 430 – 1690. This means that your immune system is currently weaker than normal and HIV has damaged your CD4 cells.
Now that you have started treatment, HIV will be suppressed in your body and your immune system will be able to naturally recover. When this low, it is recommended that you are on a treatment called co-trimoxazole. Have you started this? This is an antibiotic used to prevent other infections as your immune system currently is too weak to prevent other infections itself.
The CD4% is a more accurate version of CD4 ABS. The ABS can change when tested by the time of day and recent illness. This can make it look like the number is changing a lot when it is actually other factors other than HIV that is changing it. The CD4% is more stable and should steadily go up over time.
CD3. 1511
CD4 ABS. 120
CD4 % 7
CD8 ABS 1367
CD8 % 82
CD4 CD8 RATIO 0.09
I’ve recently tested positive and this is my results from. Tested day Please explain what does this mean am I in danger? I’ve started ART from day of testing.
Hi Lisa, in most people who are HIV negative they will have a ratio of (1-1.9):1. This means that for every CD8 cell they can have almost 2.
In your case it would mean you have almost 4 CD4 cells for every CD8 cells. When you were given these results was this explained to you?
Have you been told what your actual CD4 count is? A ratio this high would suggest you have a count about 1000.
Hi what does a 3.6: 1 cd4 cd8 ratio mean ?
Hi Andrew, this is really good. You do not need to be worried.
You have a healthy CD4 count within a normal range (430-1690) and your viral load is undetectable. This means your treatment is working and HIV is unable to destroy your CD4 cells. This means they can naturally recover, which they have, and you have a healthy immune system.
Hello.
I have been under HIV treatment for almost a year now (started in November 2022)
My CD4% is 21% and my CD8% is 50%
My CD4 and CD8 ratio is at .41
I am undetectable and have a normal range for CD4 count (580)
How bad is this? Should I be worried?
Thank you for any responses
Hi Alan, i-base is an HIV treatment charity. We are not doctors and cannot interpret blood results. Please speak with your doctor about what your results mean.
I am testing for blood cancer. Had a bone marrow biopsy and here are some Lymphocyte Gate Numbers. Are they good or bad?
CD45-100
CD10-10
CD19-15
CD20-12
CD19/CD5-1
CD2-83
Kappa: Lambda-1.9
CE3/HLA-DR-28
Hi Randy, this ratio does need to be taken into the context of healthy ranges of your cells. You do have a low CD4 count, albeit only just outside the range of healthy (430-1690). Your CD8 is elevated. A normal CD8 is between 150 and 1000. These results are both explained by HIV.
How long have you been on treatment? and how long have you been living with HIV? Overtime as your CD4 count increases it will help shift the ratio closer to 1.
Hi, hopefully someone will answer this. My VL is undetectable but my CD4 is 428 & CD8 1144. The report said the CD4:CD8 ratio is 0.37 which was considered low. I read some papers saying this means bad news for me. This is my first CD4 & VL test as I was only recently diagnosed HIV positive (almost a year). What can I do to balance out the CD4:CD8 ratio or will it ever balance out at all? Thank you.