Objective: To investigate the relationship between human papilloma virus (HPV) infection persistence and serum folate, vitamin B12, homocysteine, neopterin levels in cervical dysplasia.
Study design: Through the years 2007-2008, 122 women who have admitted to Gynecology Clinic were evaluated for cervical cytology, demographical characteristics, HPV infection, serum folate, vitamin B12, homocysteine, albumin, and neopterin levels.
Results: Considering all the cases, the highest percentage of the HPV-infected patients was in high-grade squamous intraepithelial lesion (HSIL) group (83%, n = 25). The serum folate levels in all patient groups [HSIL 10.0 ± 0.4 ng/ml, low-grade squamous intraepithelial lesion (LSIL) 10.6 ± 0.5 ng/ml, atypical squamous cells-undetermined significance (ASCUS) 11.1 ± 0.8 ng/ml] were lower than control group (11.9 ± 0.5 ng/ml; p < 0.05). The vitamin B12 levels were not significantly altered in any of the patient groups. The serum homocysteine levels in all patient groups (HSIL 10.4 ± 0.5 Umol/l, LSIL 10.1 ± 0.5 Umol/l, ASCUS 10.5 ± 0.7 Umol/l) were higher than the control group (7.9 ± 0.5 Umol/l; p < 0.05). The neopterin levels of HSIL group (1.0 ± 0.2 ng/ml) were lower than the control group (1.5 ± 0.2 ng/ml; p < 0.05). The serum neopterin concentrations of HSIL with HPV group (0.6 ± 0.1 ng/ml) were significantly lower than HSIL without HPV (2.4 ± 0.9 ng/ml) and other study groups (p < 0.05). The serum homocysteine levels of HSIL HPV(+) group and LSIL HPV(+) were higher than control group (p < 0.05). The serum albumin levels of HSIL with HPV group are lower than control and other groups (p < 0.05). In all cervical dysplasia groups, folate levels in patients infected with HPV are lower than in HPV(-) patients (p < 0.05).
Conclusions: Folic acid deficiency could be caused by insufficient cellular immunity. In case of folate deficiency, the predisposition of HPV infection persistency and progression of cervical dysplasia increase. The fact that neopterin is a strong cellular immunity marker and it was detected in patients with HPV persistence and cervical dysplasia in lower levels shows that these patients may have relatively insufficient immune system. In order for dysplasia progression to be prevented, folate fortification on diets may be advised to HPV-infected women.