Lifeline Immunology. Volume 2 issue 1(2024), Pp. 23-33 https://lifelinejournals.org/journals/lifeline-immunology Citation: Obeagu EI, Chukwu PH. CD4/CD8 Ratios as Predictors of Immune Resilience in HIV: A Review. Lifeline Immunology, 2024; 2(1): 23-33 CD4/CD8 Ratios as Predictors of Immune Resilience in HIV: A Review * 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 has emerged as a vital biomarker for assessing immune resilience in individuals living with HIV (PLWH). Traditionally, HIV management has centered on absolute CD4+ T-cell counts and viral load measurements to evaluate disease progression and treatment efficacy. However, the CD4/CD8 ratio provides a more nuanced understanding of immune function, capturing the balance between CD4+ T-helper and CD8+ cytotoxic T-cells. This review highlights the significance of the CD4/CD8 ratio as a predictor of immune resilience, detailing its role in immune recovery, chronic immune activation, and its implications for non-AIDS-related comorbidities. Research has demonstrated that a higher CD4/CD8 ratio correlates with improved immune recovery following antiretroviral therapy (ART), indicating better management of immune activation and inflammation. Conversely, a persistently low CD4/CD8 ratio despite effective viral suppression is associated with incomplete immune recovery and heightened vulnerability to chronic diseases. This ratio serves as a crucial marker for identifying patients at risk for non-AIDS-related complications, guiding clinicians in personalizing therapeutic strategies and interventions aimed at optimizing long-term health outcomes for PLWH. Keywords: CD4/CD8 ratio, immune resilience, HIV, antiretroviral therapy, immune activation Introduction The human immunodeficiency virus (HIV) continues to be a significant global public health challenge, affecting millions of people worldwide. Since its discovery, our understanding of HIV pathogenesis and treatment has evolved significantly, leading to the development of effective antiretroviral therapy (ART). However, despite substantial advancements in ART, many individuals living with HIV (PLWH) experience ongoing immune dysregulation and are at risk for