{"doi":"10.1101/2023.05.02.23289422","title":"Monocyte to Lymphocyte ratio is highly specific in diagnosing latent tuberculosis and declines significantly following tuberculosis preventive therapy: <i>a cross-sectional and nested prospective observational study</i>","abstract":"Abstract Interferon-gamma release assay and tuberculin skin test use is limited by costly sundries and cross-reactivity with non-tuberculous mycobacteria and Bacille Calmette-Guérin (BCG) vaccination respectively. We investigated the Monocyte to Lymphocyte ratio (MLR) as a biomarker to overcome these limitations and for use in monitoring response to tuberculosis preventive therapy (TPT). We conducted a cross-sectional and nested prospective observational study among asymptomatic adults living with Human Immuno-deficiency Virus (HIV) in Kampala, Uganda. Complete blood count (CBC) and QuantiFERON-TB® Gold-plus were measured at baseline and CBC repeated at three months. Multivariate logistic regression was performed to identify factors associated with a high MLR and decline in MLR. We recruited 110 adults living with HIV and on antiretroviral therapy, of which 82.5% (85/110) had suppressed viral loads, 71.8% (79/110) were female, and 73.6% (81/110) had a BCG scar. The derived MLR diagnostic cut-off was 0.35, based on which the MLR sensitivity, specificity, positive predictive value, and negative predictive value were 12.8%, 91.6%, 45.5%, and 65.7% respectively. The average MLR declined from 0.212 (95% CI: 0.190 – 0.235) at baseline to 0.182 (95% CI: 0.166 – 0.198) after three months of TPT. A viral load of &gt;50 copies/ml (aOR, 5.67 [1.12-28.60]) was associated with a high MLR while that of &lt;50 copies/ml (aOR, 0.07 [0.007-0.832 ] ) was associated with a decline in MLR. MLR was highly specific in diagnosing latent TB and declined significantly following three months of TPT. Implications of a high MLR and decline in MLR after TPT need further evaluation in a larger cohort.","journal":"medRxiv","year":2023,"id":399264,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9632,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":397657,"name":"David B. Meya","orcid":"0000-0002-8854-0321","position":1,"is_corresponding":false},{"id":1085342,"name":"Akia Miriam","orcid":null,"position":2,"is_corresponding":false},{"id":1085343,"name":"Flavia Dhikusooka","orcid":null,"position":3,"is_corresponding":false},{"id":445888,"name":"Joshua Rhein","orcid":"0000-0002-0480-9646","position":4,"is_corresponding":false},{"id":445889,"name":"Christine Sekaggya‐Wiltshire","orcid":"0000-0001-9247-2950","position":5,"is_corresponding":false},{"id":445887,"name":"Jonathan Mayito","orcid":"0000-0001-9611-2178","position":0,"is_corresponding":true}],"reference_count":22,"raw_metadata":null,"created_at":"2026-07-19T01:19:51.724387Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}