Diagnostic Performance of CD4 T-Cell Count and CD4/CD8 Ratio for Identifying HIV-Related Posterior Segment Disease: A Retrospective Single-Center Study.

Abstract

Purpose: To evaluate the diagnostic performance of CD4 T-cell count and CD4/CD8 ratio for identifying HIV-related posterior segment disease.

Methods: This retrospective study included 53 patients infected with HIV who first visited the ophthalmology department of Nara Medical University between January 2014 and December 2025. CD4 T-cell count and CD4/CD8 ratio were analyzed for their association with HIV-related posterior segment disease. Receiver operating characteristic (ROC) analysis was performed to compare the discriminatory ability of these markers.

Results: HIV-related posterior segment disease was identified in 13 of 53 patients (25%). Diagnoses included cytomegalovirus retinitis (n = 5), acute retinal necrosis (n = 1), and HIV microvasculopathy (n = 7). In univariate analysis, lower CD4 count, lower CD4/CD8 ratio, absence of antiretroviral therapy, and active cytomegalovirus infection were associated with posterior segment disease. In multivariable analysis, the CD4 count remained associated with posterior segment disease (odds ratio 0.58 per 50 cells/μL increase; 95% CI 0.33-0.99), whereas the CD4/CD8 ratio was not. ROC analysis showed a numerically higher area under the curve for CD4 count (0.81) than for CD4/CD8 ratio (0.74), although the difference was not statistically significant (p = 0.27). A CD4 threshold of ≤100 cells/μL yielded a sensitivity of 92.3% and specificity of 75.0%.

Conclusion: The CD4 T-cell count showed numerically higher discriminatory performance than the CD4/CD8 ratio, although the difference was not statistically significant. A CD4 threshold of ≤100 cells/μL showed high sensitivity and may represent an exploratory threshold.