Systemic Lupus Erythematosus Increases Incidence of High-Risk HPV

Women with systemic lupus erythematosus (SLE) are at elevated risk for high-risk (HR) HPV infection over time, according to research published in Lupus.

Mario García-Carrasco, MD, PhD, of the systemic autoimmune diseases research unit at the Mexican Institute of Social Security in Puebla, Mexico, and colleagues conducted a prospective, observational cohort study in women with SLE to determine the incidence of HPV infection.

The study included 151 participants (mean age: 45 ±11 years; 37% postmenopausal), none of whom had been vaccinated against any HPV subtypes. To assess disease activity and damage, researchers used the SLE Disease Activity Index validated for the Mexican population (mexSLEDAI) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR DI). One gynecologist conducted all clinical genital evaluations and Pap smears.

Mean disease duration among study participants was 12.7 years (range: 3 to 17 years). Mean mexSLEDAI and SLICC/ACR DI scores were 2.3 ±2.1 and 1.4 ±0.5, respectively. Following initial examination, HPV DNA was found in 29.1% of patients (77 HPV infections total); 44.1% were HR-HPV infections. Of 151 patients, 20 (13.2%) had multiple HPV infections. Most prevalent HPV infection types were 59, 62, 18, and 16.

Median follow-up was 34 months (range: 30 to 40 months); total follow-up was 4138 patient-months. Of all participants, 24 did not have a second HPV test; 127 (84.1%) women had 2 or more HPV examinations and were included in HPV infection analysis.

Dr García-Carrasco and colleagues found that the cumulative presence of HPV infection increased significantly after 3 years (22.8% at baseline vs 33.8% at 3 years; P <.001). Just over 20% of patients had a total of 43 incident HPV infections; risk of any type of HPV infection was 10.1 per 1000 patient-months.

At 3 years, the cumulative prevalence of low-risk (LR) HPV infection increased from 14.2% at baseline to 24.4% (P <.01). Cumulative prevalence of HR-HPV increased from 19.6% to 29.1% (P =.007). Cumulative presence of multiple HPV infections significantly increased from 11% at baseline to 15.7% at 3 years (P =.031).

The investigators found that potential risk factors associated with an incident HPV infection included a patient’s number of sexual partners (P =.001), prior use of antimalarial medication (P =.04), and cumulative cyclophosphamide dose (P =.02). Independent risk factors included a higher number of sexual partners (odds ratio [OR]: 1.8; 95% CI, 1.11-3.0) and cumulative cyclophosphamide dose (OR: 3.9; 95% CI, 1.2-12.8).

Summary & Clinical Applicability

The investigators noted that the link between HPV infection and SLE “involves HPV infections of all types, as well as infections by multiple HPV types, including those associated with neoplasia, such as HPV-16 and HPV-18.”

“Further research is also needed to understand the natural history of HPV in other lupus populations, including younger patients with different ethnic and socioeconomic backgrounds,” they concluded.

Study Limitations

• No healthy control group was included in the study
• Most patients included were not a part of the highest-risk age group; therefore, study results should not be applied to younger patients with SLE

Reference

Mendoza-Pinto C, Garcia-Carrasco M, Vallejo-Ruiz V, et al. Incidence of cervical human papillomavirus infection in systemic lupus erythematosus women [published online January 6, 2017]. Lupus. doi: 10.1177/0961203316686708

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