TY - JOUR
T1 - Association between monocyte-to-lymphocyte ratio and tuberculin skin test positivity in HIV-positive adults
AU - van Ginderdeuren, Eva
AU - Bassett, Jean
AU - Hanrahan, Colleen F.
AU - van Rie, Annelies
N1 - Funding Information:
This study was funded by the United States Agency for International Development (USAID, https://www.usaid.gov) under award number AID-674-A-12-00033 [EV, JB, CH, AVR], with additional funding from Vlaamse Interuniversitaire Raad (VLIR, https://www.vliruos. be) under award number NDOC2016PR001 [EV]. The content is solely the responsibility of the authors and does not necessarily represent the views of USAID or VLIR. The funders provided salary support [EV, JB, CH, AVR], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of the authors are articulated in the ‘author contributions’ section.
Publisher Copyright:
© 2021 Van Ginderdeuren et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/7
Y1 - 2021/7
N2 - Background The tuberculin skin test (TST) identifies individuals at high risk of developing tuberculosis (TB) but poses many challenges. The blood monocyte-to-lymphocyte ratio (MLR) could be an alternative, as extremes in MLR have been associated with increased risk of TB disease. Methods At a primary care clinic in Johannesburg, a differential white blood cell count and TST was performed in adults starting antiretroviral treatment (ART) without symptoms suggestive of active TB. Results Of 259 participants, 171 had valid results of whom 30% (51/171) were TST positive and the median MLR was 0.18 (IQR 0.13–0.28). The MLR distribution differed between CD4 count categories (p < 0.01), with a broader range of values in TST negative participants with a low CD4 count (≤ 250 cells/mm3), likely reflecting HIV immunosuppression. MLR was associated with a positive TST (OR 0.78 per 0.1 increase, 95% CI 0.59, 0.97) in bivariate analysis but not in multivariate regression analysis (aOR 0.83 for every 0.1 increase, 95% CI 0.60, 1.08). Conclusion In ART-naïve adults without symptoms suggestive of active TB, MLR was not independently associated with TST positivity and is thus unlikely to be a useful alternative to TST. Future research should focus on development of a cheap, simple and accurate biomarker to identify those people benefiting most from preventive TB therapy.
AB - Background The tuberculin skin test (TST) identifies individuals at high risk of developing tuberculosis (TB) but poses many challenges. The blood monocyte-to-lymphocyte ratio (MLR) could be an alternative, as extremes in MLR have been associated with increased risk of TB disease. Methods At a primary care clinic in Johannesburg, a differential white blood cell count and TST was performed in adults starting antiretroviral treatment (ART) without symptoms suggestive of active TB. Results Of 259 participants, 171 had valid results of whom 30% (51/171) were TST positive and the median MLR was 0.18 (IQR 0.13–0.28). The MLR distribution differed between CD4 count categories (p < 0.01), with a broader range of values in TST negative participants with a low CD4 count (≤ 250 cells/mm3), likely reflecting HIV immunosuppression. MLR was associated with a positive TST (OR 0.78 per 0.1 increase, 95% CI 0.59, 0.97) in bivariate analysis but not in multivariate regression analysis (aOR 0.83 for every 0.1 increase, 95% CI 0.60, 1.08). Conclusion In ART-naïve adults without symptoms suggestive of active TB, MLR was not independently associated with TST positivity and is thus unlikely to be a useful alternative to TST. Future research should focus on development of a cheap, simple and accurate biomarker to identify those people benefiting most from preventive TB therapy.
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U2 - 10.1371/journal.pone.0253907
DO - 10.1371/journal.pone.0253907
M3 - Article
C2 - 34270562
AN - SCOPUS:85110529980
SN - 1932-6203
VL - 16
JO - PloS one
JF - PloS one
IS - 7 July
M1 - e0253907
ER -