CD4/CD8 Ratio During Human Immunodeficiency Virus (HIV) Treatment: Time for Routine Monitoring?

In the last decade, studies in persons with HIV (PWH) on antiretroviral therapy (ART) have shed light on the significance of persistently high CD8 counts and low CD4/CD8 ratios. A low CD4/CD8 ratio reflects increased immune activation and is associated with an increased risk of severe non-AIDS events. As a result, many clinicians now believe that the CD4/CD8 ratio can help in HIV monitoring, and many researchers now report it as an efficacy marker in interventional studies. However, the topic is more complex. Recent studies have not yielded unanimous conclusions on the ability of the CD4/CD8 ratio to predict adverse outcomes, and only some clinical guidelines recommend monitoring it. Knowledge gaps remain on the best cutoff points, associated clinical events, effects of treatments, and how the CD4/CD8 ratio could improve decision making in the clinic. Here, we critically review the literature, identify knowledge gaps, and discuss the role of the CD4/CD8 ratio as a marker for HIV monitoring. Cumulative evidence has seeded the idea that the CD4/CD8 ratio could help monitor HIV. However, knowledge gaps exist. Here, we critically review the literature and discuss the role of the CD4/CD8 ratio in the follow-up of persons with HIV.

Automated summary

Studies have shown the significance of CD4/CD8 ratio in monitoring HIV, but there is still debate on its ability to predict adverse outcomes. Some clinical guidelines recommend monitoring it, but knowledge gaps remain on optimal cutoff points, associated clinical events, treatment effects, and decision making improvements.