Inflammation-related indices as markers for mortality in people living with HIV co-infected with <i>Talaromyces Marneffei</i>: a retrospective analysis

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. This multicenter retrospective study analyzed 282 PLWH (95 treatment-naïve T. marneffei co-infected, 187 without opportunistic infections) to evaluate six inflammatory indices: 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). Multivariate logistic regression and ROC analysis were performed to identify risk factors and prognostic performance. 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 identified thrombocytopenia (P =0.026), hypoalbuminemia (P =0.031), and lower CD4+ T-cell counts (P =0.011) as independent predictors of HIV-TM coinfection. Among the T. marneffei group, survivors (n=80) and non-survivors (n=15) exhibited distinct inflammatory profiles: NLR demonstrated optimal mortality prediction (AUC=0.788, P <0.001), outperforming NPR (AUC=0.671, P <0.001). Multivariate analysis confirmed NLR as the sole mortality predictor (P =0.041), with restricted cubic spline analysis indicating a non-linear NLR-mortality relationship. In conclusion, we found that NLR represents a reliable prognostic marker for PLWH co-infected with T. marneffei.