CD4 Cells Count in HIV patients

September 27, 2022 Helal Medical

CD4 cells are a type of white blood cells, (T-lymphocytes, also called T cells), that have an important role in the immune system against bacteria, viruses and other pathogens. CD4 count usually becomes low in an HIV patient, especially without HIV treatment. A lack of CD4 cells usually leads to more frequent infections. Normally, it is 500 to 1,600 cells per cubic millimeter.

What is CD4 Cells Count?

It is the number of blood cells in a cubic millimeter of blood. It is not a count of all the CD4 cells in your body, (Example: CD4= 900/ul)
A higher number means the person has a stronger immune system.
CD4 count test used to measures how many CD4 cells you have in your blood. It is not used to diagnose HIV infection. But it is used to monitor ART effectiveness in persons living with HIV. For HIV diagnoses we use the Antibody test, Antigen p24 test or RNA test.

Normal Values

A normal person has a CD4 count between 500 and 1500 per ul.
For those living with HIV, a count more than 500 is considered good.
If the count is less than 200/ul, then the HIV patient is at high risk of getting serious infections. HIV treatment, antiretroviral treatment (ART), will keep the count of CD4 cells under control.

When the count is less than 200 cells/mm3, (200 cells/ul), this means the person is AIDs patient, which is different from HIV patient. In persons living with HIV, the count is around 500. AIDS is an advanced condition in a person with HIV not receiving proper medications, where his immune system is weak, and the risk of infection is very high.

CD4 Cells Count in HIV patients — A diagram showing Values in AIDS, HIV and Normal persons

CD4-CD8 Ratio Test

This test looks at the ratio of 2 important types of white blood cells, (CD4 and CD8), in the blood.
If you have HIV, your CD4 count may be low.
The ratio can be an indication of the immune system status.
In addition to HIV/AIDS, it is used in some conditions like infectious mononucleosis and other viral infections, chronic lymphocytic leukemia, Hodgkin disease, aplastic anemia, and neurological disorders like multiple sclerosis and myasthenia gravis.

Question

Hello, I just started meds a month ago, my viral load dropped to 900 and I got the below lab result. I understand that a CD 4 count of 780 is good, but the lab flagged it as L for low and CD8 count as H for high. What is the significance of a high CD8 count and the ratio? Thanks
CD4 Cells (Helper) L21%
CD4 Cells Absolute (Helper) 780/uL
CD8 Cells (Suppressor) H65%
CD8 Cells Absolute (Suppressor) H2410/uL
CD4 Cells/CD8 Cells (Helper/Suppressor R L0.32

Answer
In general, a person without HIV infection has about the same number of CD4 cells and CD8 cells. When someone becomes HIV infected, the virus infects the CD4 cells which leads to a decline in CD4 count, and as a reaction to infection, the CD8 count increases. Both of these events lead to a decrease in the CD4/CD8 cell ratio. The numbers you list are very typical for someone with HIV infection.

question

i have CD4 = 400. Does it means I have HIV infection?

Answer

HIV is the most common cause of CD4 low count. But, this can be due to other causes, such as infections, autoimmune diseases, immunosuppressive therapy, lymphoma and idiopathic forms.

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