Low CDxx cell numbers

[SOC]

I think the fact CD8 is that low and the ratio is greater than 2 points to something else than HIV. But what is it?

My immunologist says my results (similar to yours -- although my CD4/CD8 ratio is much higher, >5) suggest a persistent infection. Unfortunately, we have not identified that infection and none of the treatments so far seem to be affecting the infection. It could be an as-yet-unknown infection, or an uncommon known one that we haven't tested for. Or it could be some immune dysfunction, not an infection. We just don't know. It is not suggestive of an HIV infection because 1) my HIV tests are negative and 2) HIV reduces CD4+ cells and mine are normal.

I recently became eligible for IVIG. I will have extensive immune testing next week so we will see if the IVIG is affecting anything that might change my T-cell numbers.

 

[ashler]

It could be an as-yet-unknown infection, or an uncommon known one that we haven't tested for. Or it could be some immune dysfunction, not an infection.

or it could be a known virus (e.g. HSV) that affects certain people in a different way due host particular characteristics (i.e. this wouldn't do anything in other people but it does a mess in us). Of course, this is just a theory.

 

[SOC]

or it could be a known virus (e.g. HSV) that affects certain people in a different way due host particular characteristics (i.e. this wouldn't do anything in other people but it does a mess in us). Of course, this is just a theory.

I would agree with you on this except that I've had long-term antiviral treatments that should directly affect HSV (and all other herpesviruses). That has not improved (or even stopped the decline in) my CD8+ cell numbers. If it's something relatively well known, it's probably something I haven't been treated for, such as an enterovirus for which there are no established treatments.

Even so, there's certainly the possibility of a unique factor in us (probably immune-related) that is causing us to respond differently to some pathogen(s).

 

[sorin]

I keep track of my results here.

Although my CD4 and CD8 are both in the normal range (CD4: 592 average count / 38% and CD8: 260 average count / 16% and CD4/CD8 ratio > 2) both are in the low side of the range, specially the CD8. Inmunologist has diagnosed me with a sort of immune deficiency despite I am "within the range". He suggested me an HIV test despite I took half dozen of tests including a PCR RNA qualitative in the past.

I think the fact CD8 is that low and the ratio is greater than 2 points to something else than HIV. But what is it?

As far as I know, a value Cd4/Cd8>1 is considered normal, so you should not worry. If your results are all within the range, how comes that the doctor diagnosed you with an "immune deficiency"? Based on what?
My story is a little bit different. My CD8 increased to 1058 which leads to Cd4/Cd8 to decrease to about 0.66
which is not normal. However my CD4 = 674 and the doctors were puzzled. All my HIV tests done in 2010, 2012, 2014, 2015 were negative, ECLIA, ELISA, WB, PCR.
So in my medical report the immunologist wrote "stimulation of specific cell immunity". I am wondering if he wrote that just because he had to write something on that paper - is just like saying "a day has 24 hours" or "a minute has 60 seconds".

 

[ashler]

As far as I know, a value Cd4/Cd8>1 is considered normal, so you should not worry. If your results are all within the range, how comes that the doctor diagnosed you with an "immune deficiency"? Based on what?

did you read my post above? my CD8 is very low (although still in the normal range), but low and thus my Dr. thinks I have a deficiency (like many people on this board by looking at their numbers) but he can't explain why.

 

[SOC]

As far as I know, a value Cd4/Cd8>1 is considered normal, so you should not worry.

Context. It's not normal if it's too high. Most talk about CD4/CD8 ratio is in the context of HIV where they're concerned about low CD4 and therefore low CD4/CD8 ratio. They consider higher ratios "normal" because they don't apply to HIV infections. In HIV context they probably never see high CD4/CD8 ratios, so what HIV specialists say about it is irrelevant.
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=cd4_cd8_ratio

Higher than normal results may mean you have:

• Major infection
• Viral infection
• Type of blood cancer

I'd say that makes a high CD4/CD8 ratio worth some degree of concern.

This particular article considers 2.0 to be a normal CD4/CD8 ratio. At >5, mine is decidedly abnormal.

 

[Kati]

Hi Ashler,

your CD-8 cells are in range. At this point, it is not very low. It is in the lower normal range.
While I don't deny that you are sick, it is important to not knit pick on the blood work that is within range.

I am looking forward to the day we have a blood test that describes what exactly we are feeling.

 

[ashler]

While I don't deny that you are sick, it is important to not knit pick on the blood work that is within range.

sure, but please notice the 'deficiency' statement comes from my Doctor, not me. and yes, my clinical symptoms prove that obviously something's wrong with me.

 

[SOC]

sure, but please notice the 'deficiency' statement comes from my Doctor, not me. and yes, my clinical symptoms prove that obviously something's wrong with me.

This could be as simple as the fact that one parameter being at the low end of normal is not a reason for concern, but many or all parameters being at the low end of normal might indicate a problem. It sounds to me like your doctor recognized an overall problem rather than a problem in one specific parameter only.

Too many doctors use rules of thumb at the expense of common sense and scientific logic. Normal ranges are more like estimates. They are statistical constructs, not direct measures of healthy/unhealthy. Doctors should use critical thinking and intelligence along with statistical rules of thumb to make reasonable diagnostic judgements. They rarely do, however. They tend to use the simplest, broadest rule without looking at either details or the overall picture.

 

[sorin]

did you read my post above? my CD8 is very low (although still in the normal range), but low and thus my Dr. thinks I have a deficiency (like many people on this board by looking at their numbers) but he can't explain why.

Of course that I have read it, this is why I asked you that question. Your Dr. must have a scientific base in order to make assumptions and give diagnostics such as "immune deficiency". And based on your results, the Dr. does not have any proof to say that. Just by guessing? You see, this story is common to all CFS patients - they feel bad but all tests they do are ok. So they are just sent to psychiatry by some superficial and incompetent doctors (who are so many, unfortunately).

 

[SOC]

You see, this story is common to all CFS patients - they feel bad but all tests they do are ok.

BS. All my tests are not okay. Not by a long shot. This is true of many PWME who get the right kind of testing. A lot of the basic everyday tests come up normal, but that doesn't mean all tests are normal. Only doctors who don't bother to dig and do the right tests find no abnormal test results.

 

[sorin]

Only doctors who don't bother to dig and do the right tests find no abnormal test results.

Well, all doctors I met until now (think over 100) fall into this category, so I am quite skeptical that I will ever meet other type of doctors. You can say that I was not lucky enough to meet the right doctors. But what is that probability, 0.0001% ?!? Actually after seeing more than 100 doctors, spending lots of money without any result, I am sick of these doctors. I can easily predict what the next doctor will tell me.

 

[Strawberry]

..... This is true of many PWME who get the right kind of testing. .....

So how does one get these tests ran, and by what kind of Dr? I have all my lab work from the last 5 years here today, and I can't find anything saying CD or NK anything. I don't know even where to look? I am assuming Dr Kaufman will run these labs, so hopefully in a month I will know.

I am always so confused here when people talk about lab results, and I can honestly say I have never seen or heard of these. Seattle is supposed to be progressive and modern, but when it comes to medical, I feel like I live with the dinosaurs!

 

[SOC]

So how does one get these tests ran, and by what kind of Dr? I have all my lab work from the last 5 years here today, and I can't find anything saying CD or NK anything. I don't know even where to look? I am assuming Dr Kaufman will run these labs, so hopefully in a month I will know.

I am always so confused here when people talk about lab results, and I can honestly say I have never seen or heard of these. Seattle is supposed to be progressive and modern, but when it comes to medical, I feel like I live with the dinosaurs!

The problem is your average local doctors think ME is a mild physical or a psychological condition so they don't bother to run the more involved immune and pathogen tests -- nor do they interpret them correctly in the context of immune dysfunction if they do run them. As with most other serious illnesses, it takes a specialist to know what specialist tests need to be run and how to interpret them.

Dr K knows ME so he should run the right tests. If he finds nothing abnormal, I'll be very surprised.

 

[sorin]

So how does one get these tests ran, and by what kind of Dr? Seattle is supposed to be progressive and modern, but when it comes to medical, I feel like I live with the dinosaurs!

This is why I said some time ago in one of my posts that only God can help us!

 

[Mary]

@Strawberry - Dr. Kaufman will run those tests, he did for me.

 

[Strawberry]

@Strawberry - Dr. Kaufman will run those tests, he did for me.

Thank you! I assumed he would, but I didn't know for sure.

Is there any specific reason why 99% of doctors don't care to run these tests?

 

[sorin]

Is there any specific reason why 99% of doctors don't care to run these tests?

They are incompetent and they just don't care. It is much easier for them to send patients to psychotherapy as this would be an universal panacea.

 

[SOC]

Thank you! I assumed he would, but I didn't know for sure.

Is there any specific reason why 99% of doctors don't care to run these tests?

Because they don't understand ME/CFS and therefore they don't see the need. They don't think ME/CFS is a serious physical illness, so it doesn't occur to them that these kinds of tests should be done. They think we are hypochondriacs so if we ask for these kinds of tests, they consider that evidence of attention-seeking behavior.

In other words, they're too ignorant.

 

[Mary]

@Strawberry - they are ignorant, as @SOC says. Some do believe it is "attention-seeking behavior" (who thinks up these names! argghh!), and some are well-intentioned but definitely still ignorant. Actually, I got my GP to run a few tests re viruses and NK cell function and immune function, only he didn't know what to do with the results, even though there were abnormalities. He just gave me the results and it was up to me if I was going to try to do anything further.