[Question #5433] HIV Infection and CD4/CD8 Ratio

22 months ago

Hello,I did a Comprehensive Checkup with a full blood panel last year, Everything is normal.

However, the Doctor did a test called CD4/CD8. I do not know why the doctor ordered it, as there is no indications for HIV whatsoever.

The result is as follows:

CD4 : 27.6%, Absolute Count 510

CD8: 45.3%, Absolute Count 838

CD4/CD8 Ratio: 0.61

The CD4 and CD8 is within normal ranges, however the Ratio is Inverted.

I read in the internet that HIV causes the CD4/CD8 ratio to be inverted. I became paranoid and scared and decided to do HIV Test.

Just for your information, I always have protected sex , and my last encounter before the first HIV test is 5 Months.

1. HIV 1/O/2 :  Non-Reactive ( 5 Months from Last Exposure)

2. HIV AG/AB Combo CMIA:  Non-Reactive (5 Months from Last Exposure)

3. HIV AG/AB Combo CMIA:  Non-Reactive (6 Months from Last Exposure)

4. HIV PCR Viral Load Test, Roche Cobas HIV 1 Test:  Not-Detected (7 Months From Last Exposure)

5. HIV AG/AB Combo CMIA:  Non-Reactive (7 Months From Last Exposure)

6. Alere HIV Combo Rapid Test:  Non-Reactive ( 1 Year From Last Exposure)

As you can see, the Antigen, Antibody and Viral load test is negative. Usually, i would be satisfied with a single test, however due to the abnormal inverted cd4/cd8 ratio, i would like to really make sure that there is no HIV inside me.

1. Is it possible, that i have a Rare Group M Clades ( H, J, K or something new) that is not detected by the HIV Test above? Or have a Recombinant HIV (CRF) or URF subtype that is new and thus not detected by current tests?

2. Do you think i need to do more HIV Test or other more advance tests to exclude any possibility of HIV?

3. Is it true that the CD4 CD8 test is mainly only used for a person with confirmed HIV infection? and that for a person with NO HIV, this test should never be ordered, and the results have no use?

I am Healthy, and Asymptomatic, I have no reason to suspect any HIV infection as i always practice Safe Sex and rarely have any encounters. The only reason I’m worried about HIV is because of the Inverted CD4/CD8 Ratio.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
Welcome to the forum. Thanks for your confidence in our services.

Yours is a good example of some thing not do do whenvaluating someone for potential HIV infection. First, don't do it yourself -- get professional advice, don't just go with online lab "comprehensive" panels. Second, never, ever test for CD4/CD8 if the HIV blood test is negative. CD4/CD8 has absolutely no role in diagnosing or suspecting HIV, only to assess immune system status in people with known infectiobn. In other words, this test was wacko -- either on your part, or a lab you trusted but perhaps should not have, ro on the part of a health professional if someone recommended it.

Entirely minor and common viral infections and other trivial health problems can alter CD4/CD8. Despite the slightly abnormal ratio, by far the most important aspect of the test is the absolute numbers --a nd yours are normal for both CD4 and CD8. Also, the numbers and ratio can vary widely over time, even over the course of a day (with tendency toward lower CD4 and higher CD8 in the afternoon compared to morning, if I correctly recall). (In HIV/AIDS clinics, when patients' CD4/CD8 are tested, we try to to the test about the same time of day every time to permit consistent comparisons over time.)

Your AgAb and PCR tests prove with 100% certainty you do not have HIV. Do not have any more tests. There are no HPV types (e.g. HIV2, HIV1 group M, or any other) that can be negative on all the test types you have had. You should have no more tests and if you have a regular sex partner, you should resume or continue your usual sexual practices. I see no reason for additional testing or to do anything more about your CD4/CD8 results.

I hope these comments are helpful. You can move on with no worries at all.

22 months ago
Hi Dr HHH,

Thank you for the reply.
The test was actually ordered by my physician. I was not trying to test for HIV and HIV did not even came across my mind.
It was just a comprehensive general Check up, in which, somehow, the doctor decided to order the CD4/CD8 test, and i don't know the reason for it.
When the result came out with inverted CD4/CD8 ratio. That is when i first started to worry about possible HIV infection, even though i always practice Safe sex and do not consider myself at risk of any HIV infection.

The First HIV test was also ordered by the same physician, when the result is Non-Reactive, He just told me that my Cd4 Cd8 Result is "Normal Variant"
I am a healthy 28 Year old Male, Never been Hospitalized and i rarely get sick. I do not feel that i have any immune problems whatsoever.

Just to clarify your previous feedback:

1. I have more than enough HIV test, and that i do not need anymore HIV test. The tests that i have done is conclusive and i do not have HIV.

2. The Current 4th Gen HIV test, Whether rapid or Lab based, can detect all Strains and Clades of HIV, and its not possible to get a false negative from a rare strain or Clades of HIV. I am based in Singapore, if that matters. So, Non B clade of HIV and some CRF's would be common here.

3. The CD4/CD8 test should only be done, when somebody is confirmed positive for HIV. 
In someone Negative for HIV, The test should have never been done in the first place. as you said, it is Wacko to do CD4 CD8 test in a HIV negative person.

4. Since the CD4 CD8 test have been done, and my result is mildly abnormal in the ratio. and HIV has been confirmed to be Negative.
Do you think, i need to monitor this CD4 CD8, test every 6- 12 months for example? or do you think that, since HIV has been excluded, i should
never test again for CD4 CD8 and just accept my result as a " Normal Variant"?

5. How Common is HIV Group M , Clades H, J & K?  Is it still isolated in africa, or is these strains prevalent around the world?

6. And a Technical Question regarding HIV Tests. I understand that the HIV virus is constantly Evolving, and that the hiv test mainly test for antigen (P24)
and antibodies (GP 120 & GP41 i think?) . IF, a new clades, strains, CRF, URF of HIV 1 do appear, Will the P24 , GP120, GP41 Stay the same and still be detected by current tests? Or do the tests need to be continually updated with the proteins of the new strains? The Abbott Architect AB/AG test for example, is first approved by FDA in 2010. Its been 9 years since the test is used. i'm sure in that 9 years, new strains,Clades, CRF's, URF's have appeared. Do Abbott Continually add new hiv proteins into the test, or is the P24 and antibodies for HIV 1 Group M Similar for all clades , CRF's,  URF's that no modification of the test is needed and the test would still reliably detect new emerging strains. I hope you understand what i'm trying to ask.

Thankyou again for your expertise and advice.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
1-4) You correctly understand. There are other potential reasons for CD4/CD8 assessment, unrelated to HIV. But rarely as part of a routine sceening blood test panel. You should ask your physician why s/he ordered it and whether follow-up testing is recommended.

5,6) This asks for more detail than I know. These HIV types clearly are very rare. It is in the diagnostic companies' benefit and their high priority to produce the most accurate possible tests. I believe they routinely monitor and respond accordingly to data that emerge about the frequency and rate of evoluation or introduction of new strains or variations on old ones that might affect test reliability and have or will modify their products if and when their frequency warrants it. 

Finally, determining whether or not someone has HIV is not dependent only on test results. You haven't described your potential exposure history, but the typical case presented on this forum has a risk under one in several thousand, based on the likelihood a partner had HIV and the nature of the exposure (condom use, particular sexual practices, etc). If the estimated risk is, say, 1 chance in 100,000 to one in a million of catching HIV -- probably the range for most forum questions -- a test that is "only" 99% sensitive reduces the chance the person has HIV to 1 chance in 10 to 100 million. That should be viewed as 100% conclusive for all practical purposes. In other words, the test result must not be viewed in a vacuum, strictly on test performance alone. For those reasons, your concerns about rare types may not be a high priority.
22 months ago
Dear Dr HHH,

Thank you for the reply.

My doctor cant explain why he ordered the test. There is no clinical indication for the test really, since i do not have any clinical symptoms and was just asking for a general check up. Not a very good doctor i guess.
When the CD4/CD8 ratio result came out and was inverted, all he did was order an HIV test "just to be safe".
and when the result negative, he just said that my CD4 CD8 is a "normal Variant" and not to worry about it.

Anyway, now that HIV have been ruled out conclusively, would you be worried about this Inverted CD4 CD8 ratio?
I understand that you said that this test should only be done mainly for people who have positive HIV tests.

This will be my 3rd and last question,
Thankyou again Dr HHH, for your advice.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
22 months ago
I wouldn't give the CD4/CD8 result a second though. But this still is a question for your doctor. Even if he didn't explain a reason, e.g. if he does this a routine health screening step in all his patients, he did order the test and has to be expected to advise responses to the results and steps going forward if any. But as a wild guess, perhaps he or others in his practice were in the habit in the early HIV/AIDS days, when the blood tests were new and less reliable (1980s-90s) of including CD4/CD8 automatically in people tested for HIV -- and simply haven't moved ahead with the times and more recent recommendations. In any case, I'll have nothing more to say about it.

"You said that this test should only be done mainly for people who have positive HIV test". I also said there are other potential reasons -- see my first response to your second round of questions.

Thanks for the thanks. I hope the discussion has been helpful.