A Six-Year Gynecological Follow-Up of Immunosuppressed Women with a High-Risk Human Papillomavirus Infection

Abstract

Immunocompromised women are at an increased risk of developing malignancies, especially those that are viral-induced, such as invasive cervical cancer caused by the human papillomavirus (HPV). The aim of the study was to describe gynecological follow-up of women undergoing chronic immunosuppressive therapy for various reasons (e.g., kidney/liver transplant, systemic lupus erythematosus), diagnosed with a high-risk HPV (hrHPV) infection based on a self-sampling test. Twenty-six hrHPV-positive women were invited to take part in a gynecological follow-up, including a visual assessment of the anogenital region, two-handed gynecological examination, and cervical cytology as well as a colposcopy and cervical biopsy when necessary. Four women declined taking part in the study. Over six years of observation, low-grade squamous intraepithelial lesions (LSIL) were detected at least once in 7/22 women (31.8%), and a cervical intraepithelial lesion 1 (CIN 1) histopathologic result was obtained five times in 3/22 women. No cases of high-grade squamous intraepithelial lesions, CIN 2/3, or invasive cervical cancers were observed. Loop electrosurgical excision procedure (LEEP) was performed in three patients. As immunocompromised women are prone to persistent hrHPV infections, they should be under strict gynecological supervision because only vigilant surveillance enables fast detection and treatment of early dysplasia and, therefore, provides a chance for the reduction of the cervical cancer burden.

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia

“…For high-grade SIL of the vagina (VaIN 2/3) treatment should be tailored according to location, extension, and focality of the disease. 142 , 143 …”

“…Treatment is considered for bulky warty disease depending on symptoms. For high-grade SIL of the vagina (VaIN 2/3) treatment should be tailored according to location, extension, and focality of the disease 142,143 …”

“…For high-grade SIL of the vagina (VaIN 2/3) treatment should be tailored according to location, extension, and focality of the disease. 142,143 There is no evidence concerning the best treatment of VaIN in immunocompromised patients. Topical treatments such as imiquimod or 5-FU are acceptable and have proved to be effective in an immunocompetent population, 97,144 particularly in treating multicentric HPV-related diseases without aggressive and mutilating surgery.…”

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

“…These medical conditions can be congenitally acquired, such as in the case of epidermodysplasia verruciformis [ 2 ], or non-congenitally acquired. The latter category includes people living with human immune deficiency virus (HIV), those with cancer undergoing chemotherapy, chronically immunosuppressed individuals, or those who have undergone organ transplantation [ 3 , 4 ].…”