CD4/8 Ratios to worry ?

Question

I am not nor have not been on any HIV/AIDs meds. I have been pos for about 10 yrs. I'm concerned that I may be moving towards having to take meds after all these years. on Mar./2000 my c4/c8 ratio was 0.7 . CD4 500+ and VL undect. ON 7/00 cd4/cd8 ratio at 0.58 VL undect. cd4 500+ on Jan/01 cd4/cd8 0.62 VL 89 cd4 500+ ON 6/01 cd4/cd8raito 0.67 , VL213, cd4 500+ My doctor keeps saying I'm fine but I see a progression here. Would it be safe to say I'm progressing towards a weaker immune system, and close to needing meds ? Please provide some insight to help me converse intelligently with my doctor, or perhaps change doctors since my current one seems to think everything is ok and I don't agree. thank you! very much! JR

Answer

I don't put too much weight on the ratio. Remember that the ratio is a function of both kinds of T cells. HIV infection causes the CD8 count to increase and the CD4 count to decrease. A decrease in the CD4 count or an increase in the CD8 count or both, can decrease the ratio. I would look more at the CD4 percentage as a more durable measure of CD4 number. If the CD4 count and percentage have remained the same, then I would not worry. The undetectable or barely detectable viral loads, in the absence to therapy, indicate to me that your immune system has been very successful in containing HIV replication. I would continue to monitor your numbers, unless there is much greater movement in either the CD4 count or viral load, I would not recommend treatment either. The current guidelines suggest starting treatment in people with CD4 counts < 350, and viral loads > 30-55,000/ml. You are far away from those numbers. MH