Hi:

I'm 54yo, male, asyptomatic and infected less than 2 years. my last 3 T-cell counts (approx 3-4 mo apart) were practically identical in absolute count - about 470 - but the percentage has dropped sharply from 25% to 18%. This seems to be because my CD8's have gone into overdrive from 1000 to 1700. Viral load tending up from 40K to 70K. My CD4/CD8 ratio once holding steady at 0.5 is now suddenly 0.3

What is the significance of these high CD8 counts? If I were your patient would you be recommending I start treatment?

Thanks in advance for your advice.

Hello and thanks for posting. Since you are asymptomatic and the absolute CD4 counts remain high I would not recommend treatment if you were my patient. I would simply continue to trend the counts over the coming year. I have seen 3 consecutive declines in percentages inexplicably reverse and go back to where they were, so what looked like a trend turned out not to be.

But I have also seen percentage CD4 count declines herald a subsequent decline in absolute CD4 counts, so if this trend is verified on subsequent readings it would be reasonable to begin therapy.