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

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.