Association of Neutrophil-Lymphocyte Ratio and Monocyte-Lymphocyte Ratio with Opportunistic Infections in Patients with HIV Infection

Opportunistic infection is a problem that is often found in patients with HIV infection which contributes to high rates of morbidity and mortality. The incidence of opportunistic infections will increase with advanced progression of HIV infection and further decline of the immune system. Several leucocyte subsets, including neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) have been shown its potential of inflammatory marker in various diseases and infection. The objective of this study is to evaluate the relationship of NLR and MLR with opportunistic infections in patients with HIV infection. This is a single center, cross-sectional, and retrospective study conducted in Voluntary Counseling and Testing (VCT) clinics at Wangaya General Hospital. Patients aged 18 years old or older confirmed with HIV infection are included, except those with co-existing chronic hepatitis, malignancy, and pregnancy. From 110 subjects included, 45 (40.9%) had opportunistic infections with 25 (55.6%) and 20 (44.4%) of them are na?ve and on HAART respectively. Oral-esophageal candidiasis was the most common opportunistic infection (26.4%), followed by pulmonary tuberculosis (11.8%), toxoplasmosis and pneumocystis pneumonia (7.3%), herpes zoster (6.4%), and extrapulmonary tuberculosis and CMV infection (0.9%). NLR, MLR, and CD4 count had significant relationship with the presence of opportunistic infections (pless than0.001), with correlation coefficient of NLR (r = 0.47, p less than0.001) MLR (r = 0.59, p less than0.001) and CD4 count (r= -0.69, p less than0.001). The result of this study suggests the role of NLR and MLR as a simple and widely available parameter available to raise suspicion of possible opportunistic infection in HIV infected patients in areas of limited resources.