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Interpreting CD8 while taking ART

Apr 28, 2013

Dear Doctor,

I have had HIV for around 28 years but undetectable on Atripla or its components since 2005. In looking at my medical records, I see that my CD8 has always been elevated beyond CD4, as is typical with HIV. At the most recent count, I was at CD4 822 - CD8 990.

What I don't really understand is why the CD8 seems to move up and down at the same time that CD4 does, while the ratio has gradually improved for CD4 while taking ART. I understand the relationship between CD4 and ART, but CD8 is still a bit hazy to me.

Elevated CD8 with uncontrolled virus is understandable, but if my HIV has been suppressed for so many years, why should my body continue to produce so much CD8? What is the clinical significance of the CD8 count and ratio while taking ART, and if by chance there is no significance then why are we measuring it?

If you know of any informative publications that address the topic of CD8 changes (or not) in long-term ART, please let me know and I'll take a look.


Response from Dr. Holodniy

I would not consider your CD8 level that high for HIV infection, or for HIV infection which is under control with HIV meds. In most people it never normalizes, and in some, it can remain in the thousands. The normal range is also variable, depending on gender and ethnicity. As you know, CD8 cells are important in controlling HIV infection, hence the increase in number and response with infection. However, too many CD8 cells can be a bad thing, and maybe the result of other ongoing infections or medical problems. Some studies suggest that when the CD8 count is sustained at > 1200-1500 during HIV infection, increased inflammation resulting in other medical problems or perhaps HIV treatment failure is possible. Measuring CD8 cells is usually not important in everyday management of HIV infection, and in my opinion, is related to historical considerations when we did look at things like the CD4/CD8 ratio more closely. That said, having CD8 counts now has allowed researchers to better understand the relationship between CD8 count, HIV infection, treatment response, and inflammatory syndromes.

Urgent! I am running out of ISENTRESS® (raltegravir) - options what to do

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