Question:

Based on review of various publications on the subject of inverted CD4/CD8 ratio, it appears that all HIV positive individuals, who are not on any medication, will always have significantly more cd8s than cd4s, the fundamental characteristic of the body's response to the virus and that also this inverse pattern develops and remains true from the point of infection throughout any and all stages thereafter. It also seems that in the majority of cases the inverted ratio of cd8 to cd4 becomes even greater with progression of time, again, if no medications are taken.

Is the aforementioned condition an invariable finding in all ( or at least, 99% of..) HIV + individuals ? If so, using the reverse criteria, can it be concluded with near certainty that anyone whose tests consistently reflect a normal (1.5 + ) cd4/cd8 ratio (approx. 4 years + post an HIV exposure ) is HIV negative , particularly with both cd4 and cd8 absolute, and percentages counts within the normal values ranges for healthy individuals ?

Answer provided by:

Peter Shalit, M.D.
Internal Medicine

The inverted CD4/CD8 ratio is an interesting observation which dates way back to the early days of the HIV epidemic. However, it is not a universal characteristic of untreated, HIV-infected people. I have taken care of numbers of folks who have normal CD4/CD8 ratios despite having HIV infection. You seem to be asking if the CD4/CD8 ratio is a good surrogate test to determine the presence or absence of HIV infection. My answer is that it is not. I also wonder why one would do a test that costs a couple hundred dollars (CD4 subsets) when a very inexpensive test (HIV antibody) can answer the question with more certainty?

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