What to do if the cd4cd8 ratio is too high

The values ​​of CD4 and CD8 are the values ​​of the human immune system. Generally, we look at our lymphocytes, because lymphocytes are distributed in various parts of our body. They exist in the form of liquid, which we cannot see with our eyes because it is colorless. If CD4 is higher than CD8, our immune system is easily infected by inflammation. So what should we do if the ratio of CD4 to CD8 is high?

CD4 and CD8: important components of lymphocytes in the human immune system. Lymphocytes have anti-infection and tumor immunity functions. CD4 plays a role in transmitting information, while CD8 plays a role in killing infected cells and cancer cells.

HIV attacks CD4 cells, so its test results play an important role in determining the effectiveness of AIDS treatment and the patient's immune function.

The normal adult's CD4 cells are between 500 and 1600 per cubic millimeter in the blood. A decrease in the CD4 cells of HIV-infected people indicates that the immune system is severely damaged. When the CD4 cells are less than 200 per cubic millimeter, a variety of opportunistic infections or tumors may occur.

-After infection and attack by HIV, can drug treatment restore the CD4/CD8 ratio to normal?

able!

Normal value range: 0.71-2.78 (Beijing Youan Hospital 2016 testing standard)

How long does it take to return to normal after treatment?

A study of 3236 patients who received antiretroviral therapy for more than 2 years found that:

Before treatment, the average CD4/CD8 ratio was about 0.39, and after treatment, only 14% of patients achieved a ratio greater than 1 or normal;

Under the standard line, the estimated normalization rate was 4.4% after 1 year of treatment, 11.5% after 2 years, and 29.4% after 5 years, with an average time of 10.1 years to normalize the ratio.

What factors affect the normalization of the ratio?

1. The CD4 cell count and CD4/CD8 ratio are too low;

2. Simultaneous infection with CMV (cytomegalovirus) or HCV (hepatitis C virus);

3. The elderly and those with poor physical condition before infection;

4. It takes a long time to achieve viral suppression or the treatment is started late or the duration of viral suppression is short;

5. Patients receiving antiviral treatment with AZT (zidovudine) + 3TC (lamivudine) (compared with TDF + FTC);

6. The CD4/CD8 ratio is inversely proportional to the percentage of T cell activation indicators CD38+HLA-DR+CD4+T cells and CD57+CD8+T cells. Therefore, T cell activation indicators are independent risk factors affecting the normalization of the CD4/CD8 ratio.

What clinical references does the CD4/CD8 ratio have?

1. Studies on HIV-infected patients who have received effective treatment have found that even if the CD4 count of some patients has returned to normal (>500 cells/μl), their CD4/CD8 ratio still cannot normalize, leading to an increased incidence of age-related non-AIDS-related diseases, such as cardiovascular, kidney, nervous system, bone and tumors. The probability of non-AIDS-related events in people with a CD4/CD8 ratio less than 0.3 is twice that of a ratio of 0.3 to 0.45, which is significantly higher than that of a ratio greater than 0.45. These all indicate that normalizing the CD4/CD8 ratio will help reduce the morbidity and mortality of non-AIDS-related diseases.

2. Patients with a low CD4/CD8 ratio show a series of abnormal immunological characteristics, including more terminally differentiated (senescent) CD8 cells than immature (newborn) CD8 cells, higher levels of CD8 cell activation (CD38+HLA-DR+) and immune silence phenotype (CD28- and CD57+CD28-), and a higher kynurenine/tryptophan ratio. The failure of the CD4/CD8 ratio in peripheral blood (blood outside the bone marrow) to normalize can also indirectly reflect changes in the CD4/CD8 ratio in the intestinal mucosa.

3. Studies have reported that the CD4/CD8 cell ratio is positively correlated with the peripheral fat content after standardization for height. For every 0.1 increase in the CD4/CD8 cell ratio, the peripheral fat content increases by 2.6%.

4. The CD4/CD8 ratio has a good auxiliary predictive value for diagnosing HIV infection in infants under 2 years old. Reports show that the CD4/CD8 ratio level in HIV-positive infants under 18 months of age is significantly lower than that in HIV-negative individuals, and its sensitivity and specificity as an auxiliary diagnosis of HIV infection in this population are both higher than 98%.

5. In addition, a low CD4/CD8 ratio before antiviral treatment is still a good indicator for clinically predicting the occurrence of Hodgkin's lymphoma.