Prevalence of anal HPV infection in solid-organ transplant patients prior to immunosuppression

Abstract

Patients that undergo organ transplantation have a high risk of developing various malignancies, depending on the duration and magnitude of immunosuppressive therapy. Among others, a 10-fold increased relative risk has been reported for the development of anal cancer. There is a strong association between persistent infection with high-risk mucosal types of human papillomavirus (HPV) and anogenital neoplasia. In this study we analysed the prevalence of anal HPV infection in organ transplant patients before starting immunosuppressive therapy. In a university transplant unit, patients ( n=60, 40 male, 20 female) that were undergoing solid-organ transplantation (kidney, liver) for the first time were routinely screened for anal HPV infection. Anal swabs were obtained within 24 h after transplantation and analysed for the presence of mucosal-type HPV DNA by liquid DNA/RNA hybridization [hybrid capture (HC) 2 test]. Overall, some type of HPV DNA was detected in 14/60 (23.3%) patients; 9/60 (15%) were positive for high-risk HPV and 8/60 (13.4%) were positive for low-risk HPV, and 3/60 (5%) were positive for both types. Prevalence of HPV infection tended to be higher in patients that were receiving liver transplants than in those receiving kidney transplants (29.4% vs. 20.9%), but the difference did not reach statistical significance. In our series of organ transplant patients the prevalence of previous HPV infection (23.3%) before immunosuppressive therapy was started was higher than that found in previous epidemiological studies or in a control group. In particular, there was a high rate (15%) of infection with oncogenic HPV types. These findings have important implications on screening and surveillance policies in this patient group at risk of developing neoplasias, including anal cancer.

Prevalence of Human Papilloma Virus Infections and Cervical Cytological Abnormalities among Korean Women with Systemic Lupus Erythematosus

“…In particular, persistent infection with high-cancer-risk HPV type 16 and 18 is major risk factor for cervical cancer (2). In the case of immunocompromised host, the risk of HPV infection was reported to be much greater than the general population due to high-load, persistent infection with oncogenic HPV genotypes (3-6). The prevalence of HPV infection was shown to increase in organ transplant recipients (3, 7), human immunodeficiency virus (HIV)-infected women (4-6), and patients with systemic autoimmune diseases such as systemic lupus erythematosus (SLE) (8, 9).…”

Human papillomavirus infection and anal dysplasia in renal transplant recipients

“…Malignant progression from high‐grade AIN (AIN III) to ASCC was reported in 9 per cent (3 of 35) and 11 per cent (8 of 72) of other cohorts8, 9, and was more likely in the presence of immunosuppression. The prevalence of anal high‐risk HPV infection was 47 per cent (36 of 76) in the renal transplant cohort from 19946 and 9 per cent (4 of 43) in 200410. The latter study examined transplant recipients within 24 h of transplantation and reduced HPV infection was to be expected owing to the short duration of immunosuppressant therapy.…”

Anal cancer: Current standards in care and recent changes in practice

“…Progression of AIN to anal cancer is more likely associated with immunosuppression . The prevalence of anal HPV‐16, HPV‐18, HPV‐6, or HPV‐11 in liver transplant patients 3 weeks after transplantation has been reported at 18%, which is similar to the overall HPV prevalence in liver and kidney transplant patients within 24 hours of transplantation (29% and 21%, respectively) …”