Lifeline Immunology. Volume 2 issue 1(2024), Pp. 12-22 https://lifelinejournals.org/journals/lifeline-immunology Citation: Obeagu EI, Chukwu PH. The Immunological Compass: CD4/CD8 Ratios in HIV Management. Lifeline Immunology, 2024; 2(1): 12-22 1 The Immunological Compass: CD4/CD8 Ratios in HIV Management * Emmanuel Ifeanyi Obeagu 1 and Priya Homa Chukwu 2 1 Department of Medical Laboratory Science, Kampala International University, Ishaka, Uganda. 2 Department of Haematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, rivers State, Nigeria. * Corresponding authour: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science, Kampala International University, Uganda, emmanuelobeagu@yahoo.com, ORCID: 0000-0002-4538-0161 Abstract The CD4/CD8 ratio is an important immunological marker in the management of HIV, offering a deeper understanding of immune function and disease progression beyond the CD4+ T-cell count. This ratio reflects the balance between CD4+ helper T-cells and CD8+ cytotoxic T-cells, with disruptions in the ratio indicating immune dysfunction and heightened immune activation. In HIV- infected individuals, the ratio often falls below 1, reflecting the depletion of CD4+ T-cells and the expansion of CD8+ T-cells, which is indicative of chronic immune activation and inflammation. Antiretroviral therapy (ART) plays a crucial role in restoring immune function by reducing viral load and promoting CD4+ T-cell recovery. However, even with virological suppression, not all patients experience a full restoration of the CD4/CD8 ratio. The ratio is increasingly recognized as a predictive biomarker for ART efficacy, non-AIDS comorbidities, and long-term health outcomes, such as cardiovascular disease and neurocognitive decline. A higher pre-ART CD4/CD8 ratio is often associated with better immune recovery and overall clinical prognosis. Keywords: CD4/CD8 ratio, HIV, immune reconstitution, antiretroviral therapy (ART), immunological recovery Introduction