Evaluation of Systemic Inflammation- and Nutrition-Based Indices in the Prediction of HPV Persistence

Aim: Persistent high-risk human papillomavirus (HPV) infection is the primary etiological factor in cervical cancer, with HPV16 and HPV18 posing the greatest oncogenic risk. Although systemic inflammation and nutritional indices such as the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and Prognostic Nutritional Index (PNI) have prognostic value in various malignancies, their role in predicting HPV persistence remains unclear. This study aimed to evaluate the predictive value of HALP and PNI scores for one-year HPV persistence. Methods: This retrospective study included 470 HPV-positive women aged 31–67 years, followed for at least one year between January 2021 and March 2025. Participants were divided into Group N (HPV clearance, n=271) and Group P (HPV persistence, n=199) based on one-year HPV results. Baseline demographic, clinical, histopathological, and laboratory data were recorded. HALP and PNI scores were calculated from hemoglobin, albumin, lymphocyte, and platelet counts. Group comparisons were performed using appropriate statistical tests, and predictive performance was assessed via receiver operating characteristic (ROC) analysis. Results: There were no significant differences between groups in age, marital status, smoking, contraceptive use, parity, delivery mode, or chronic diseases. HPV16 (44.7%) and HPV18 (27.1%) positivity were significantly higher in the persistence group (p<0.001 and p=0.0006, respectively). Histopathological findings and p16/Ki-67 expression did not differ significantly. Post-diagnosis HPV vaccination did not affect clearance rates (p=0.604). Median HALP scores were 49.11 (IQR 35.87–60.42) in Group N and 46.97 (IQR 35.49–59.23) in Group P (p=0.361). Median PNI scores were 55.30 (IQR 51.40–58.40) and 55.00 (IQR 51.10–58.20), respectively (p=0.637). ROC analysis indicated poor predictive performance (AUC=0.531 for HALP; AUC=0.516 for PNI). Conclusions: HALP and PNI scores were not predictive of one-year HPV persistence, indicating limited influence of systemic inflammation and nutritional status on viral clearance in localized cervical HPV infections. HPV16 and HPV18 positivity was strongly associated with persistence, supporting their known immune evasion mechanisms. These findings highlight the need for prognostic markers targeting local mucosal immune responses to improve risk stratification and management of HPV-related disease.