CD4+ T-lymphocyte count/CD8+ T-lymphocyte count ratio: surrogate for HIV infection in infants?

J Trop Pediatr. 2012 Oct;58(5):394-7. doi: 10.1093/tropej/fmr102. Epub 2012 Jan 6.


Introduction: Early diagnosis and treatment is necessary to prevent HIV-infected infants progressing to AIDS. Antibody testing is not confirmatory before the age of 18 months and PCR not widely available in resource-poor settings. We studied the accuracy of CD4(+) T-lymphocyte count, CD4% and CD4/CD8 ratio as surrogate markers of infant HIV infection.

Methods: Two hundred and fifty-eight HIV-exposed Indian infants at a median age of 5 months (range 1-18) had DNA PCR and CD4, CD8 counts performed.

Results: Fifty five infants tested positive by HIV-1 DNA PCR whereas 203 were negative. Median CD4 count, CD4% and CD4/CD8 ratio were significantly lower in DNA PCR+ infants. Overall sensitivity and specificity of CD4/CD8 ratio <1.0 in predicting HIV was 91 and 92% with a negative predicted value (NPV) and positive predicted value (PPV) of 97 and 76%, respectively.

Conclusion: CD4/CD8 ratio <1.0 is a more sensitive surrogate marker of HIV infection in Indian infants than a CD4 count <1500 cells/µl or CD4% <25%.

MeSH terms

  • Anti-HIV Agents / therapeutic use
  • Biomarkers / blood
  • CD4-CD8 Ratio*
  • CD4-Positive T-Lymphocytes / immunology*
  • CD8-Positive T-Lymphocytes / immunology*
  • Female
  • Flow Cytometry
  • HIV Infections / blood
  • HIV Infections / diagnosis
  • HIV Infections / immunology*
  • HIV Infections / virology
  • HIV-1
  • Humans
  • India
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
  • Lymphocyte Count
  • Male
  • Polymerase Chain Reaction
  • Predictive Value of Tests
  • Prospective Studies
  • Sensitivity and Specificity
  • Sex Distribution


  • Anti-HIV Agents
  • Biomarkers