Association of the monocyte-to-lymphocyte ratio with HIV viral load and anemia in HIV-positive patients: a retrospective cross-sectional study

Background HIV is a chronic viral infection characterized by persistent immune activation and various clinical complications, including anemia, which has been associated with accelerated progression to AIDS. The monocyte-to-lymphocyte ratio (MLR) is an emerging complete blood count (CBC)-derived inflammatory biomarker, but its relevance to HIV viral burden and HIV-associated anemia remains insufficiently explored. This study evaluated the associations of MLR with HIV viral load and anemia among HIV-positive patients in Saudi Arabia. Materials and methods Demographics, clinical, and laboratory data were retrospectively retrieved from 103 HIV-positive patients at King Khalid University Hospital between 2017 and 2025. Patients with missing clinical and key laboratory data required for the primary analyses, including hemoglobin concentration and HIV viral load, were excluded, resulting in a final cohort of 84 patients. The associations of MLR with HIV viral load and anemia were comprehensively evaluated using group comparisons, correlation analysis, regression analysis, and receiver operating characteristic (ROC) curve analysis. Results MLR levels were significantly higher in patients with high HIV viral load (0.5: 0.267–0.8) than in those with low viral load (0.25:0.183–0.446). Similarly, anemic HIV-positive patients showed significantly elevated MLR levels (0.5: 0.259–0.848) compared with non-anemic patients (0.24:0.173–0.3905). Furthermore, among anemic HIV-positive patients, MLR was significantly higher in those with high viral load compared to their counterparts. MLR demonstrated modest discriminatory performance for high HIV viral load and anemia in the study cohort. In addition, elevated MLR was significantly associated with increased odds of high HIV viral load (OR = 3.72, p = 0.0052) and anemia (OR = 4.21, p = 0.0027). Discussion MLR was significantly associated with high HIV viral load and anemia in HIV-positive individuals, suggesting its potential relevance as a simple and routinely available CBC-derived marker in this population. However, larger prospective multicenter studies are needed to further evaluate its potential clinical utility.