Imbalance in the game of T cells: What can the CD4/CD8 T-cell ratio tell us about HIV and health?

In a population study of solid neoplasms, an inverted CD4/CD8 ratio is associated with metastatic disease as compared with cancer patients without metastasis [19]. [...]following acute myocardial infarction and cardiopulmonary resuscitation, a fixed low CD4/CD8 ratio is a poor prognostic sign [20]. Later cohort studies in Spain and the United Kingdom found that while a low CD4/CD8 ratio was associated with time to death in unadjusted analyses, no association between the ratio and morbidity was found in multivariable analyses [22,23]. In HIV and CMV coinfection, persistent low levels of CMV replication are associated with lower CD4/CD8 ratios both at diagnosis and while on ART [43]. [...]reductions of activated CD8 T cells are seen in the setting of short-term CMV treatment with valganciclovir in the coinfected [44]. Early ART is also shown to reduce the size of the HIV reservoir [27,44]. [...]the use of the CD4/CD8 ratio as a peripheral surrogate of the HIV reservoir is a hypothesis worthy of investigation.