| Summary: | Abstract Background Early detection of tuberculosis (TB) in children living with HIV (CLHIV) is crucial for improving clinical outcomes and reducing disease transmission. This study aimed to evaluate the association between hematological parameters, including the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and anemia status, and the presence of TB in CLHIV aged 0–14 years. Methods This retrospective cohort follow-up study included data from 276 CLHIV registered at the Antiretroviral Therapy (ART) Centre of a Tertiary Care Hospital in Gujarat, India, from January 2009 to March 2024. Demographic, clinical, and laboratory data were extracted from electronic medical records. Logistic regression models were developed to assess the predictive ability of hematological parameters for TB. Results Among the study population, 56.9% had moderate anemia, and 11.2% had severe anemia. Children with TB had significantly lower mean hemoglobin levels, higher absolute neutrophil counts, and higher median MLR (0.460 ± 0.117 vs. 0.167 ± 0.143, p = 0.001) and NLR ratios (2.1 ± 0.3 vs. 1.7 ± 0.7, p = 0.001) compared to those without TB. Model 1 (MLR and anemia status) showed that individuals with a greater MLR ratio had 15.62 times higher adjusted odds of having TB (95% CI: 6.84–35.67, p < 0.001). Model 2 (NLR and anemia status) revealed that a high NLR ratio was associated with 17.28 times higher adjusted odds of TB (95% CI: 7.41–40.35, p < 0.001). Model 3 (MLR, NLR, and anemia status) demonstrated the best predictive ability (AUC = 0.892, accuracy = 88%, sensitivity = 94.2%). Conclusion Higher MLR and NLR ratios were associated with increased odds of having TB in CLHIV. The combination of these hematological parameters, along with anemia status, exhibited promising predictive ability for TB in this population. These findings highlight the potential utility of routinely available hematological parameters in predicting TB disease in CLHIV.
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