Haematological profile of HIV positive adults co-infected with pulmonary tuberculosis: a nested cross-sectional study in Uganda

Background: Tuberculosis an endemic disease in Uganda contributes to over 30% of deaths among people living with HIV (PLHIV). Challenges in early diagnosis and monitoring common in limited resource settings underscore the need for more cost effective and reliable methods to improve patient outcomes. Hematological parameters have emerged as potential markers for predicting and monitoring TB disease. This study aimed to evaluate the hematological parameters among HIV/TB co-infected patients enrolled from both outpatient and inpatient health facility settings in Uganda. Methods: A nested cross-sectional study involving 120 participants (active-TB-40; latent-TB-25; no-TB-55) was conducted from June 2024 to May 2025 at Kisenyi HCIV (outpatient) and Kiruddu Hospital (inpatient) in Uganda. Venous blood was collected in ethylene diamine tetra acetic (EDTA) tubes and analyzed using flow cytometry technique. C-reactive protein (CRP) was measured using the immunoturbidimetry and nephelometry method. Data obtained was analyzed using Stata version 23. Results: The active-TB group showed lower red blood count, hemoglobin, hematocrit, mean cell hemoglobin and mean cell volume compared to the latent-TB and no-TB groups (p=0.001). CRP was significantly higher in the active TB group (p=0.001). The active-TB group had high total WBC count (p=0.02) with increased neutrophil count (p=0.003). No significant differences were observed in lymphocyte counts across the 3 patient groups (p=0.217). Conclusions: Hematological parameters provide a reliable tool for risk profiling and monitoring among PLHIV coinfected with TB especially in resource limited settings. Therefore, integrating these parameters in routine care and management for TB/HIV patients may improve patient outcomes.