Cervicovaginal HPV Infection in Female Renal Transplant Recipients: An Observational, Self-Sampling Based, Cohort Study

Abstract

Immunosuppressive treatment of organ transplant recipients is associated with an increase in the occurrence of human papillomavirus (HPV) related anogenital (pre)malignancies. This cohort study investigated the genotype-specific prevalence of HPV infections in a large cohort of female renal transplant recipients (RTRs). Participants self-collected a cervicovaginal sample for detection and genotyping of HPV. Besides, they completed a questionnaire regarding sociodemographic variables, medical data and sexual behavior. Anogenital screening was offered to all HPVpositive participants. A total number of 218 female RTRs was included. The prevalence of mucosal HPV infections was 27.1% and 17.4% for high risk HPV in particular. The studied cohort showed a broad range of HPV genotypes and multiple HPV genotypes were found in 27.1% of HPV-positive patients. Seven participants were identified with occult premalignant anogenital lesions. In conclusion, this study shows a high point-prevalence of HPV in female RTRs (agematched West-European general population: 9-10%) with a shift in the distribution of genotypes as compared with the general population. Moreover, a substantial number of patients with occult premalignancies was identified. The introduction of selfsampling for HPV positivity can help in early detection of (pre)malignant anogenital lesions in this vulnerable population.Abbreviations: HPV, human papillomavirus; hrHPV, high risk human papillomavirus; lrHPV, low risk human papillomavirus; RR, relative risk; RTRs, renal transplant recipients

Immunodeficiency-associated viral oncogenesis

“…Reports in HIV+ patients [66], in older women [67] and in transplant [68] are in keeping with this hypothesis. In this latter population having less at-risk sexual behaviours, increased HPV infections and high-grade lesions rates were recently reported [68], differently from previous studies. Therefore, even in the absence of clinically evident lesions and of novel infections, undetected persistence and reactivation of past HR HPV infections would represent an additional risk in immune suppressed women.…”

“…Given the ability of HPV DNA to persist long-term in the absence of disease, mucosal immune dysfunction may cause latent HPV reactivation at local sites, despite patient general immune reconstitution [64,65]. Reports in HIV+ patients [66], in older women [67] and in transplant [68] are in keeping with this hypothesis. In this latter population having less at-risk sexual behaviours, increased HPV infections and high-grade lesions rates were recently reported [68], differently from previous studies.…”

Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD

“…Lack of baseline antibody levels for some patients is also a limitation; however, a very low prevalence of prevaccination HPV exposure to HPV genotypes 6, 11, 16, and 18 was observed in those patients with baseline data. It is also important to note that patients with transplants who have responded to the quadrivalent HPV vaccine may continue to have higher risk of HPV-related morbidity because of complications from HPV strains not included in the vaccine (35) and b-HPVs (36).…”

Human papillomavirus‐related anogenital premalignancies and cancer in renal transplant recipients: A Danish nationwide, registry‐based cohort study

“…Several large, population‐based registry studies have found that RTRs have an increased risk of HPV‐associated anogenital cancers compared to the general population . It has been hypothesized that the immunosuppressive treatments received by RTRs decrease their ability to clear newly acquired HPV infections and/or increase their risk of reactivation of latent HPV infections . In accordance with this hypothesis, an Australian registry study found that the risk of HPV‐related cancers in RTRs was higher during periods of functioning graft than during periods of dialysis where immunosuppressive treatment is withdrawn or substantially reduced …”