Inflammation-Related Indices as Markers for Mortality in People Living with HIV Co-Infected with Talaromyces Marneffei: A Retrospective Analysis

Abstract Talaromyces marneffei (T. marneffei) co-infection remains a significant cause of mortality in people living with HIV (PLWH). Although early detection of individuals at high risk is essential, there remains a lack of markers to predict outcomes. Our multicenter retrospective study included 282 individuals, with 95 treatment-naïve PLWH with T. marneffei infection and 187 without opportunistic infection. Clinical data were collected and six inflammation-related indices were calculated: Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Platelet Ratio (NPR), and Pan-Immune Inflammation Value (PIV). Logistic regression was performed to identify independent factors and prognostic value was assessed using ROC curves. The results revealed that T. marneffei group exhibited significantly elevated levels of SII, NPR, NLR, and PLR (P<0.001), with lower LMR (P<0.001) and PIV levels (P=0.014). Logistic regression analysis revealed that reduced platelet count (P=0.026), decreased albumin (P=0.031), and lower CD4+ T cell counts (P=0.011) as independent factors associated with concurrent HIV and TM infection. We next categorized the T. marneffei group into survival (n=80) and non-survival (n=15) groups and compared the variations in inflammation indices between the two groups. NLR demonstrated the highest predictive ability for mortality (AUC=0.788, P<0.001), followed by NPR (AUC=0.671, P<0.001). However, multivariate analysis confirmed NLR as the sole independent predictor of mortality (P=0.041), with restricted cubic spline analysis showing a non-linear relationship between NLR and mortality risk. In conclusion, we found that NLR emerged as a reliable and convenient marker for predicting mortality risk in PLWH co-infected with T. marneffei.