Immuno-Hematological Profiles of HIV-Positive Patients Stratified by CD4+ T-Cell Counts: Toward Identifying a Surrogate Hematological Marker for Immune Suppression Severity

<b>Background/Objectives</b>: The CD4⁺ T-cell count is a primary indicator of immune status in HIV-positive patients. Rapid identification of immune suppression severity may improve clinical decision-making and triage. The relationship between CD4⁺ counts and other immunologic and hematologic markers, however, is not well characterized, especially in resource-limited settings. The objectives of this study were to classify HIV-positive patients by CD4⁺ T-cell count, compare hematologic and immunologic markers across severity groups, assess correlations between CD4⁺ and other variables, and evaluate routine blood tests' potential to serve as surrogate indicators of immune status. <b>Methods</b>: A retrospective cohort of 229 HIV-positive patients from the Regional Laboratory in Makkah, Saudi Arabia, was stratified into three groups: severe (<200 cells/mm³), moderate (200-500 cells/mm³), and preserved (>500 cells/mm³). Hematologic (RBC, Hb, Hct, ESR, WBC, and lymphocytes) and immunologic (CD3, CD4, CD8, B, NK cells, and CD4/CD8 ratio) data were analyzed using ANOVA and Pearson correlation. <b>Results</b>: Significant group differences were observed in RBC, Hb, Hct, ESR, and lymphocyte counts (<i>p</i> < 0.001). CD4⁺ counts correlated positively with CD3 (r = 0.76), B cells (r = 0.63), and CD8⁺ (r = 0.41) and negatively with ESR (r = -0.37). Over 75% of the patients had disrupted CD4/CD8 ratios, and one-third of the severely immunosuppressed patients showed abnormal B- and NK-cell counts. <b>Conclusions</b>: Routine hematologic markers reflect immune suppression severity and can serve as accessible, low-cost tools for monitoring HIV-positive patients in resource-limited settings. Integrating these parameters into immune monitoring may enhance early assessment and provide regional benchmarks for clinical evaluation.