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Cd4 and CD4/CD8 ratio
Oct 5, 2002

Dear Keith, I have been recently diagnosed HIV+ (June 02) and have some questions regarding both the CD4/CD8 ratio and CD4 which do not seem to be spoken about as much as the CD4 absolute. My first question is what exactly are CD8 cells? What happens to them with HIV infection? My understanding is that they increase - is this correct and if so when in the course of infection (after how long)does this happen? Secondly what is the meaning/significance of the CD4/CD8 ratio? My doctor said that with HIV infection this declines/inverts - without meds what level does this ratio fall to and again when does this happen (immediately after infection or after a few months, a year??) Final question is re the CD4.How quickly does this fall on average per year without meds? What is the range? What weight do you place on the when someone has a >35 but a low CD4 because of a low WBC? Would you still start meds if the CD4 went below 350?

Thanks in advance for your response and for the great service you do - your work has certianly made the shock of HIV infection easier to deal with

Jim

Response from Dr. Henry

The rate of fall in CD4 count is quite variable. The normal situation is that there are more helper cells than suppressor cells so the helper/suppressor ration (CD4/CD8) is greater than 1.0. With HIV infection there is a fall in the helper cell count (numerator) and a rise or no change in the CD8 count so the ratio falls below 1.0. The suppressor cell is felt to play a key role in controlling HIV replication (possibly by releasse of antiviral proteins which are the subject of alot of investigation). The CD4 count of 350 as a threshold for starting therapy is not an absolute. If a person has symptoms likely due to HIV or a fast drop in CD4 and a high viral level (i.e. > 100,000) then starting therapy may be wise. On the flip side, if a person has a CD4 count < 350 but it is not changing much (i.e. at 300) and the viral load isn't very high (i.e. < 30,000) and no symptoms then waiting may be wise. Thus--there are alot of variables and a cookbook approach is not recommended= best to see an open minded HIV specialist with the time to spend with you. KH



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