Publication:

Vitamin B12 and folate: key predictors of HPV persistence in ASCUS patients

Background Persistent infection with high-risk human papillomavirus (HPV) is the key driver of cervical carcinogenesis. Atypical squamous cells of undetermined significance (ASCUS) represent an equivocal cytology category in which optimal triage is crucial. Disturbances in one-carbon metabolism, particularly low vitamin B12 and folate, may impair DNA repair and immune responses, favouring HPV persistence. This study aimed to evaluate serum vitamin B12 and folate levels in women with ASCUS compared with cytologically normal controls and to explore their association with HPV positivity in ASCUS.

Methods This comparative cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, FH Medical College, Agra. Fifty women were enrolled: 25 with ASCUS cytology and 25 age-matched controls with normal Pap smears. Socio-demographic and clinical data were recorded. Fasting serum vitamin B12 and folate were measured using an automated immunoassay. High-risk HPV status in the ASCUS group was determined by PCR. Group comparisons were performed using appropriate statistical tests and the association between micronutrient levels and HPV positivity was assessed.

Results Women with ASCUS had significantly lower vitamin B12 (265.17±54.25 vs 315.26±65.62 pg/ml, p<0.01) and folate (9.53±1.76 vs 11.91±2.62 ng/ml, p<0.01) than controls. Within the ASCUS group, HPV-positive women showed markedly reduced vitamin B12 (200.14±12.47 vs 295.53±40.25 pg/ml, p<0.01) and folate (7.86±0.61 vs 10.23±1.59 ng/ml; p<0.01) compared with HPV-negative ASCUS patients. Lower micronutrient levels showed a clear inverse association with HPV positivity.

Conclusions Women with ASCUS, particularly those who are HPV-positive, exhibit significant subclinical deficiencies of vitamin B12 and folate. These findings suggest that impaired one-carbon metabolism may contribute to HPV persistence at an early stage and that vitamin B12 and folate could serve as simple, adjunctive biomarkers to refine risk stratification and follow-up strategies in ASCUS patients.