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Monocyte-to-lymphocyte ratio as a predictor of TB among people living with HIV

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BACKGROUND: Diagnostic tools to identify incipient or subclinical TB stages will be helpful for preventive intervention. A simple biomarker to predict TB may be the monocytes to lymphocytes ratio (ML ratio) in peripheral blood.

METHODS: We assessed the relationship between multiple time-updated ML ratio measurements and incidence of TB in people living with HIV (PLWH) after antiretroviral therapy (ART) was initiated. The ML ratio was updated at least every 6 months. TB incidence with corresponding 95% confidence intervals stratified according to time-updated ML ratio was calculated using ML ratio in quartiles.

RESULTS: A total of 1305 PLWH were included in the analyses: 46 had incident TB and 1259 remained TB-free. The TB incidence rate was 10.3 (95% CI 7.1–14.9) cases/1000 patient-years (PYR) among participants with ML ratio ≥0.25 compared with 1.1/1000 PYR (95% CI 0.4–2.9) among those with ML ratio <0.15. At cut-point 0.23, the ML ratio provided a diagnostic area under the receiver operating characteristics curve (AROC) of 0.849 (95% CI 0.784–0.914) and a sensitivity of 85% and specificity of 71%.

CONCLUSION: Increased ML ratio was predictive of incident TB among PLWH on or after ART. The ML ratio can be a simple tool to stratify the risk of TB in PLWH.

Keywords: HIV; ML ratio; monocytes; predictor; tuberculosis

Document Type: Research Article

Affiliations: 1: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand 3: HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand, Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, Bangkok, Thailand 4: Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands, Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, the Netherlands 5: Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, the Netherlands

Publication date: November 1, 2021

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