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

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.