Here's what the DHHS guidelines say: "Monitoring of lymphocyte subsets other than CD4 (e.g., CD8, CD19) has not proven clinically useful and is more expensive than monitoring CD4 count alone; therefore, it is not recommended (BIII).
Even measuring the ratio is not recommended, not because it's not important, but because there's nothing you would do different based on the results.
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Joel Gallant, MD, MPH
Santa Fe, NM
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Original Message:
Sent: 09-17-2024 17:21
From: Veronica Ayala-Sims
Subject: CD4:CD8 Ratio
I have a patient with a CD4 count of 638 (33.8%) and undetectable viral load. He has been HIV positive since 2002, currently on Biktarvy. He is insisting that because his CD4:CD8 ratio is 0.65 that I need to do a lymphocyte enumeration panel, specifically to look at his B and NK cells, as he is concerned that he is heading toward medication failure. I have reassured him that such testing is not necessary- that low ratios can be seen in immune senesence or "may" be implicated in non AIDS related events. However, just checking to make sure that I'm not missing something. Thoughts?
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Veronica Ayala-Sims
Richmond VA
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