COVID-19 related immune dysregulation including impaired interferon signaling, reduced cytotoxic T-cell activity, and sustained inflammatory imbalance may contribute not only to delayed screening but also to true biological persistence of high-risk HPV (HR-HPV). This study investigated whether prior COVID-19 infection influences cervical HR-HPV persistence and associated cytological abnormalities. In this retrospective study, 738 h-HPV positive women without baseline high-grade lesions or immunocompromising conditions were included. The study group comprised 372 women with PCR confirmed symptomatic COVID-19, while those without confirmed infection served as controls. Patients with prior excisional cervical procedures, other STDs, pregnancy, or incomplete follow-up data were excluded. HR-HPV DNA and cervical cytology were assessed at standardized follow-ups at at mean intervals of approximately 10 and 19 months, and persistence rates were compared. Cervical HR-HPV persistence was significantly higher in COVID-19 positive patients at both follow-up visits (p = 0.007 and p = 0.021). Persistence of HPV 16 was also significantly higher in the COVID-19 positive group (p = 0.021), whereas HPV 18 persistence did not differ between groups (p = 0.851). Cervical cytology and colposcopy findings were comparable between groups at both visits (p = 0.873, p = 0.606, and p = 0.927, p = 0.751). Importantly, after adjusting for potential confounders including age, smoking status, baseline cytology, and COVID-19 vaccination, a history of COVID-19 infection remained a significant independent risk factor for HR-HPV persistence (aOR: 1.81, p < 0.001). Prior COVID-19 infection was associated with increased HR-HPV persistence, particularly HPV 16. If confirmed by larger prospective studies, these findings may warrant intensified follow-up protocols for women with concurrent HR-HPV positivity and a history of COVID-19 infection. Prospective immunologic studies are additionally required to clarify how COVID-19 related immune alterations may influence HPV clearance.
Şahin et al. (Tue,) studied this question.