Diagnostic Accuracy of the IL-10/TNF-alpha Ratio and TNF-alpha for HIV-Malaria Co-infection in Adults in Warri, Nigeria: A Cross-sectional Study
Aghatise, Kevin Erhamwonyi
*
Department of Haematology and Blood Transfusion Science, Igbinedion University, Okada, Edo State, Nigeria.
Olagboye Josephine Abhankonfoh
Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Mudiame, University, Edo State, Nigeria.
Mokwenye, Victoria Ngozi
Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Wellspring University, Edo State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: This study evaluated the diagnostic accuracy of the IL-10/TNF-alpha ratio, TNF-alpha alone, and neutrophil percentage for distinguishing HIV-malaria co-infection from malaria-only and HIV-only mono-infection among adults in Warri, Delta State, Nigeria.
Study Design: Hospital-based, descriptive, comparative, cross-sectional diagnostic-accuracy study.
Place and Duration of Study: Central Hospital, Warri, together with selected secondary health facilities in Warri, Delta State, Nigeria, from May 2026 to 30 July 2026.
Methodology: Serum TNF-alpha and IL-10 were measured by enzyme-linked immunosorbent assay, whereas neutrophil percentage was measured using an automated full blood count in three groups of adults (n = 70 each): malaria only, HIV only, and HIV-malaria co-infection. Receiver operating characteristic (ROC) curve analysis was used to evaluate each marker's ability to distinguish co-infection from each mono-infection group.
Results: The IL-10/TNF-alpha ratio and TNF-alpha alone showed high discriminatory performance, with area under the curve (AUC) values of 0.92-0.97 and 0.93-0.96, respectively, across the pairwise comparisons. The ratio distinguished co-infection from malaria only with an AUC of 0.97 (sensitivity 87.1%, specificity 94.3%), while TNF-alpha distinguished co-infection from HIV only with an AUC of 0.96 (sensitivity 90.0%, specificity 98.6%). Neutrophil percentage showed more modest performance (AUC 0.67-0.69).
Conclusion: The IL-10/TNF-alpha ratio and TNF-alpha alone showed substantially greater discriminatory performance than neutrophil percentage for distinguishing HIV-malaria co-infection from mono-infection in this study population. The proposed cut-offs are exploratory because they were derived and evaluated in the same dataset and require prospective validation in independent populations before clinical use.
Keywords: Diagnostic accuracy, HIV-malaria co-infection, tumour necrosis factor alpha, interleukin-10, IL-10/TNF-alpha ratio, receiver operating characteristic curve, neutrophil percentage, cytokine biomarkers, malaria, HIV