TY - JOUR
T1 - Monocyte to lymphocyte ratio and hemoglobin level to predict tuberculosis after antiretroviral therapy initiation
AU - Gatechompol, Sivaporn
AU - Kerr, Stephen J.
AU - Cardoso, Sandra W.
AU - Samaneka, Wadzanai
AU - Tripathy, Srikanth
AU - Godbole, Sheela
AU - Ghate, Manisha
AU - Kanyama, Cecilia
AU - Nyirenda, Mulinda
AU - Sugandhavesa, Patcharaphan
AU - Machado, Andre
AU - van Leth, Frank
AU - Campbell, Thomas B.
AU - Swindlells, Susan
AU - Avihingsanon, Anchalee
AU - Cobelens, Frank
N1 - Funding Information: Funding support for this trial was provided by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Numbers UM1 AI068634, UM1 AI068636 and UM1 AI106701 and CRS 31802 - Thai Red Cross AIDS Research Centre (TRCARC) CRS, (CTU grant number 5UM1AI069399) (SG, SK and AA). Publisher Copyright: © 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Objective:To determine the performance of the baseline monocyte to lymphocyte ratio (MLR), baseline anemia severity and combination of these biomarkers, to predict tuberculosis (TB) incidence in people with HIV (PWH) after antiretroviral therapy (ART) initiation.Design:Multicenter, retrospective cohort study.Methods:We utilized the data from study A5175 (Prospective Evaluation of Antiretroviral Therapy in Resource-limited Settings: PEARLS). We assessed the utility of MLR, anemia severity and in combination, for predicting TB in the first year after ART. Cox regression was used to assess associations of MLR and anemia with incident TB. Harrell's C index was used to describe single model discrimination.Results:A total of 1455 participants with a median age of 34 [interquartile range (IQR) 29, 41] were included. Fifty-four participants were diagnosed with TB. The hazard ratio (HR) for incident TB was 1.77 [95% confidence interval (CI) 1.01-3.07]; P = 0.04 for those with MLR ≥0.23. The HR for mild/mod anemia was 3.35 (95% CI 1.78-6.29; P < 0.001) and 18.16 (95% CI 5.17-63.77; P < 0.001) for severe anemia. After combining parameters, there were increases in adjusted HR (aHR) for MLR ≥0.23 to 1.83 (95% CI 1.05-3.18), and degrees of anemia to 3.38 (95% CI 1.80-6.35) for mild/mod anemia and 19.09 (95% CI 5.43-67.12) for severe anemia.Conclusions:MLR and hemoglobin levels which are available in routine HIV care can be used at ART initiation for identifying patients at high risk of developing TB disease to guide diagnostic and management decisions.
AB - Objective:To determine the performance of the baseline monocyte to lymphocyte ratio (MLR), baseline anemia severity and combination of these biomarkers, to predict tuberculosis (TB) incidence in people with HIV (PWH) after antiretroviral therapy (ART) initiation.Design:Multicenter, retrospective cohort study.Methods:We utilized the data from study A5175 (Prospective Evaluation of Antiretroviral Therapy in Resource-limited Settings: PEARLS). We assessed the utility of MLR, anemia severity and in combination, for predicting TB in the first year after ART. Cox regression was used to assess associations of MLR and anemia with incident TB. Harrell's C index was used to describe single model discrimination.Results:A total of 1455 participants with a median age of 34 [interquartile range (IQR) 29, 41] were included. Fifty-four participants were diagnosed with TB. The hazard ratio (HR) for incident TB was 1.77 [95% confidence interval (CI) 1.01-3.07]; P = 0.04 for those with MLR ≥0.23. The HR for mild/mod anemia was 3.35 (95% CI 1.78-6.29; P < 0.001) and 18.16 (95% CI 5.17-63.77; P < 0.001) for severe anemia. After combining parameters, there were increases in adjusted HR (aHR) for MLR ≥0.23 to 1.83 (95% CI 1.05-3.18), and degrees of anemia to 3.38 (95% CI 1.80-6.35) for mild/mod anemia and 19.09 (95% CI 5.43-67.12) for severe anemia.Conclusions:MLR and hemoglobin levels which are available in routine HIV care can be used at ART initiation for identifying patients at high risk of developing TB disease to guide diagnostic and management decisions.
KW - Anemia/epidemiology
KW - CD4 Lymphocyte Count
KW - HIV
KW - HIV Infections/complications
KW - Hemoglobins/analysis
KW - Humans
KW - Incidence
KW - Lymphocytes
KW - Monocytes/chemistry
KW - Retrospective Studies
KW - Tuberculosis/diagnosis
KW - hemoglobin
KW - monocyte lymphocyte ratio
KW - predictor
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85179496254&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/QAD.0000000000003713
DO - https://doi.org/10.1097/QAD.0000000000003713
M3 - Article
C2 - 37696248
SN - 0269-9370
VL - 38
SP - 31
EP - 38
JO - AIDS
JF - AIDS
IS - 1
ER -