Anogenital Human Papillomavirus Prevalence is Unaffected by Therapeutic Tumour Necrosis Factor-alpha Inhibition

Abstract

Patients receiving tumour necrosis factor alpha (TNF-α) inhibitors are at increased risk of exacerbation of (myco-)bacterial and some viral infections. However, information on anogenital human papillomavirus (HPV) infection in these patients is sparse or conflicting. In this study 222 patients with psoriasis or inflammatory bowel disease (IBD), who received either anti-TNF-α inhibitors or alternatives (purine-, folic acid analogues, phototherapy, fumaric ester, mesalazine) continuously for at least 6 months, were evaluated for the presence of anogenital HPV-induced lesions, mucosal HPV DNA, and serological status of mucosal low-risk HPV6 and high-risk HPV16/HPV18. Hallmarks of anogenital HPV infection were more frequently detected in patients with psoriasis than in those with IBD. HPV-induced lesions, viral DNA, and seroprevalence were not elevated in participants with psoriasis or IBD, who received TNF-α inhibitors for a mean duration of 31.4 months (range 6-96 months) compared with recipients of alternative or no treatment. TNF-α blockade for a mean period of 31.4 months does not increase detectable anogenital HPV infection or disease.

Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016

“…Compared with patients not receiving immunosuppressive treatment, patients with IBD receiving azathioprine show a higher incidence of cutaneous warts and skin and genital herpes flares [59]. Although some studies have reported the development or worsening of genital condyloma in patients with IBD treated with anti-tumour necrosis factor (TNF) antibodies such as infliximab and etanercept [60,61], other studies suggest no relationship between the use of TNF antibodies and persistent HPV infection [62].…”

Human papillomavirus infection with anogenital warts in a patient with chronic psoriasis: A case report

“…Apart from some rare skin diseases, a high prevalence of HPV infections is also related to the treatment of psoriasis with psoralen-ultraviolet-A but not with tumor necrosis factor alpha inhibitors. 6,7 However, in our case, the patient had not received any of these treatments in the past 3 years before having anogenital warts. Carnero et al 8 reported a case of multiple warts on psoriasis plaques and considered HPV to be involved in the pathogenesis of psoriasis.…”

Human papillomavirus infection with anogenital warts in a patient with chronic psoriasis: A case report

“…Apart from some rare skin diseases, a high prevalence of HPV infections is also related to the treatment of psoriasis with psoralen‐ultraviolet‐A but not with tumor necrosis factor alpha inhibitors 6,7 . However, in our case, the patient had not received any of these treatments in the past 3 years before having anogenital warts.…”