Human papilloma virus-related premalignant and malignant lesions of the cervix and anogenital tract in immunocompromised women

Abstract

The number of immunocompromised patients is rising, and immunodeficiency is an independent risk factor for the development of premalignant and malignant lesions of the cervix and anogenital tract. The aim of this review was to summarize and update data on human papilloma virus (HPV) infections and HPV-based anogenital lesions detected in patients who were immunocompromised due to both organ transplantation and human immunodeficiency virus (HIV) infection. The incidence of HPV infections among solid organ recipients and HIV positive females is reported to be significantly higher when compared with age-matched healthy controls-i.e. higher by up to 65% and 46.6% respectively, vs 38% in the controls. These infections are also more often chronic, high risk HPV and multitype. Data suggest that HPV infections in these patients might not only occur more frequently, but that the course of the infection might also lead to faster oncogenesis. However, the treatment options for malignancies are limited; and this implies the need for intense primary and secondary prevention regimens. As infections with HPV types other than 16 and 18 and multitype infections are particularly frequently discovered in immunocompromised patients, they would probably benefit most from a nonavalent vaccine. Gynecological screening should be performed annually, including cervical smears and/ or HPV testing. In the group of non-responders, self-sampling methods should be considered.

Opportunistic Infections in the Immunocompromised: Hiv Vs Non-HIV Patients - A Narrative Review

“…Lower CD4 cell counts have a direct relationship with HPV infection, pre-cancerous lesions, and risk of anogenital cancers 132 . HIV-positive patients also present a higher prevalence -44.8% to 91.2% -and persistence of HRHPV 134,135 . Even with emergence of ART incidence of HPV-related cancers remained elevated in PLWH 132 .…”

“…Clinical manifestations are the same as in the general population. However, anogenital warts, AIN and CIN occur more frequently in PLWH, with prevalence of CIN estimated at about 20-40% 134 . Cervical cancer in PLWH is more aggressive and less responsive to standard therapies, resulting in a poor prognosis 126 and has a high risk of relapse and higher mortality 132 .…”

“…Survival after treatment of anal and oropharyngeal cancer is similar in PLWH and in the general population 132 . Vaccination in HIV-patients has been shown to be safe and provide immunogenic benefits 126,134 . Immunosuppression causes a reactivation of latent HPV infection with a decrease in viral clearance and consequently persistence of HPV 135 .…”

“…Immunosuppression causes a reactivation of latent HPV infection with a decrease in viral clearance and consequently persistence of HPV 135 . The incidence of HPV infections is higher among immunosuppressed patients such as OTR and autoimmune diseases 134,135 . Immunosuppression is also an independent risk factor for the development of HPV-related neoplasms because it decreases the capacity to eradicate HPV and enables HPV replication in infected cells 136 .…”

“…Immunosuppression is also an independent risk factor for the development of HPV-related neoplasms because it decreases the capacity to eradicate HPV and enables HPV replication in infected cells 136 . This risk reaches 20% after 10 years of immunosuppression -three to five times higher than the general population 134 and is linked to the dose and duration of immunosuppressive therapies 134 . Clinical manifestations are the same as in the general population, although with more severe forms.…”