Gatechompol Sivaporn, Kerr Stephen J, Cardoso Sandra W, Samaneka Wadzanai, Tripathy Srikanth, Godbole Sheela, Ghate Manisha, Kanyama Cecilia, Nyirenda Mulinda, Sugandhavesa Patcharaphan, Machado Andre, Van Leth Frank, Campbell Thomas B, Swindlells Susan, Avihingsanon Anchalee, Cobelens Frank
HIV-NAT, Thai Red Cross AIDS Research Center.
Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
AIDS. 2024 Jan 1;38(1):31-38. doi: 10.1097/QAD.0000000000003713. Epub 2023 Sep 8.
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.
Multicenter, retrospective cohort study.
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.
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.
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.
确定基线单核细胞与淋巴细胞比值（MLR）、基线贫血严重程度以及这些生物标志物的组合在预测接受抗逆转录病毒治疗（ART）的HIV感染者（PWH）发生结核病（TB）方面的性能。
多中心回顾性队列研究。
我们利用了A5175研究（资源有限环境中抗逆转录病毒治疗的前瞻性评估：PEARLS）的数据。我们评估了MLR、贫血严重程度及其组合在预测ART后第一年发生TB方面的效用。采用Cox回归评估MLR和贫血与TB发病的关联。使用Harrell's C指数描述单模型判别力。
共纳入1455名参与者，中位年龄为34岁[四分位间距（IQR）29，41]。54名参与者被诊断为TB。MLR≥0.23者发生TB的风险比（HR）为1.77[95%置信区间（CI）1.01 - 3.07]；P = 0.04。轻度/中度贫血者的HR为3.35（95%CI 1.78 - 6.29；P < 0.001），重度贫血者为18.16（95%CI 5.17 - 63.77；P < 0.001）。合并参数后，MLR≥0.23的调整后HR（aHR）增至1.83（95%CI 1.05 - 3.18），贫血程度方面，轻度/中度贫血为3.38（95%CI 1.80 - 6.35），重度贫血为19.09（95%CI 5.43 - 67.12）。
常规HIV护理中可获得的MLR和血红蛋白水平可在开始ART时用于识别发生TB疾病的高危患者，以指导诊断和管理决策。
