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Background <p>The immune-inflammation indexes such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and prognostic nutritional index (PNI), are recognized bioindicators for inflammation during HIV/AIDS, making them valuable indicators for clinical practice. This study aims to comprehensively evaluate the predictive value of immune inflammatory markers (NLR, PLR, MLR, and PNI) for the prognosis of HIV/AIDS patients through a systematic review and meta-analysis.</p> Methods <p>This systematic review and meta-analysis was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Cochrane Library, and Web of Science were thoroughly searched until July 31, 2025. The odds ratio (OR)/standard mean differences and 95% confidence interval (95% CI) were extracted. A random-effects model was selected to synthesize all data. The stability of results and potential sources of heterogeneity were explored through sensitivity and subgroup analyses.</p> Results <p>A total of 15 studies with 28,190 patients(mean age: 35.81 years; 67.72% male) were included. A higher NLR predicted a greater risk of mortality (OR: 2.01, 95% CI: 1.49–2.73, I<sup>2</sup> = 57%) and cancer (OR: 1.27, 95% CI: 1.01–1.60, I<sup>2</sup> = 40%) in people with HIV/AIDS. Subgroup analyses found that study design, sample size, region, age, CD4<sup>+</sup>T-cell count ≤ 350 cells/µL and cut-off value were the sources of heterogeneity in the prediction of mortality by NLR. AIDS-related cancer patients with high PLR values had a greater risk of cancer (OR: 1.28, 95% CI: 1.11–1.49, I<sup>2</sup>= 0%). In subgroup analyses, PLR &gt; 150 predicted higher mortality risk (OR: 3.14, 95% CI: 1.03–9.56). Patients with higher MLR levels had a higher mortality rate (OR:1.83, 95% CI: 1.01–3.32, I<sup>2</sup> = 0%) and a greater risk of tuberculosis (OR: 2.40, 95% CI: 1.07–5.41, I<sup>2</sup> = 81%). Patients with lower PNI levels had a greater risk of cancer (OR: 1.14, 95% CI: 1.03–1.25, I<sup>2</sup> = 61%).</p> Conclusion <p>NLR, PLR, MLR, and PNI are reliable and valuable biomarkers for predicting the prognosis of adult patients with HIV/AIDS. Integrating these indicators into clinical practice may help improve risk stratification for mortality and complications, especially in resource-limited settings.</p> Clinical trial number <p>Not applicable.</p>

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Prognostic value of immune-inflammation indexes for the clinical outcomes of HIV/AIDS: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月9日

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  • Xiyuan Song,
  • Runze Guo,
  • Pengfei Meng,
  • Xiuxia Ma,
  • Shuqing Jin,
  • Liran Xu

摘要

Background

The immune-inflammation indexes such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and prognostic nutritional index (PNI), are recognized bioindicators for inflammation during HIV/AIDS, making them valuable indicators for clinical practice. This study aims to comprehensively evaluate the predictive value of immune inflammatory markers (NLR, PLR, MLR, and PNI) for the prognosis of HIV/AIDS patients through a systematic review and meta-analysis.

Methods

This systematic review and meta-analysis was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Cochrane Library, and Web of Science were thoroughly searched until July 31, 2025. The odds ratio (OR)/standard mean differences and 95% confidence interval (95% CI) were extracted. A random-effects model was selected to synthesize all data. The stability of results and potential sources of heterogeneity were explored through sensitivity and subgroup analyses.

Results

A total of 15 studies with 28,190 patients(mean age: 35.81 years; 67.72% male) were included. A higher NLR predicted a greater risk of mortality (OR: 2.01, 95% CI: 1.49–2.73, I2 = 57%) and cancer (OR: 1.27, 95% CI: 1.01–1.60, I2 = 40%) in people with HIV/AIDS. Subgroup analyses found that study design, sample size, region, age, CD4+T-cell count ≤ 350 cells/µL and cut-off value were the sources of heterogeneity in the prediction of mortality by NLR. AIDS-related cancer patients with high PLR values had a greater risk of cancer (OR: 1.28, 95% CI: 1.11–1.49, I2= 0%). In subgroup analyses, PLR > 150 predicted higher mortality risk (OR: 3.14, 95% CI: 1.03–9.56). Patients with higher MLR levels had a higher mortality rate (OR:1.83, 95% CI: 1.01–3.32, I2 = 0%) and a greater risk of tuberculosis (OR: 2.40, 95% CI: 1.07–5.41, I2 = 81%). Patients with lower PNI levels had a greater risk of cancer (OR: 1.14, 95% CI: 1.03–1.25, I2 = 61%).

Conclusion

NLR, PLR, MLR, and PNI are reliable and valuable biomarkers for predicting the prognosis of adult patients with HIV/AIDS. Integrating these indicators into clinical practice may help improve risk stratification for mortality and complications, especially in resource-limited settings.

Clinical trial number

Not applicable.