Inverted CD4+/CD8+ ratio associated with AIDS event and death in HIV-1 infected individuals in Nasarawa State, Nigeria.

The current guidelines for the use of antiretroviral therapy in Nigeria places emphasis on the use of CD4+ enumeration to take decision of initiating antiretroviral therapy and HIV disease monitoring. CD4+ counts are known to be inherently inconsistent and therefore could be misleading. This study was undertaken to analyze the CD4+/CD8+ ratio vis-à-vis CD4+ in HIV-1 infected individual in North Central Nigeria and to correlate these immunological parameters to AIDS event and death in relation to gender and age of patients. Cell counts were carried out using a Fluorescence Activated Cell Sorter (FACS) that quantifies CD4+ and CD8+ T lymphocytes as absolute numbers of lymphocytes per microL of blood and the CD4+/CD8+ T lymphocyte ratio recorded in an automated fashion. A total of 290 HIV-1 positive persons were enrolled for this study. The median CD4+/CD8+ ratio were 0.05, 0.27, 0.64 in patients with CD4+ counts of < 50, 51-200, > 350 respectively. CD4+/ CD8+ of 0.05 and 0.27 were corresponding predictors of AIDS-related event and death. Patients with > 0.64 are predictive of better disease prognosis and low progression to AIDS. The CD4+/CD8+ were minimally higher in female patients with a median CD4+/CD8 ratio of 0.27. The age distribution of our patients at point of first entry was not found to influence CD4+/CD8+ ratios. These findings provide basic and critical CD4+/CD8+ cut-off values in predicting HIV disease progression and an alternative to absolute CD4+ counts at predicting the onset of HIV related disease. These data are useful to determine when intervention with antiretroviral therapy is needed and to determine the likelihood of virological failure.